Individual
DR. SCOTT ROBERT KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3 PARK PL, SWANSEA, IL 62226-2965
(618) 222-9244
(618) 222-9248
Mailing address
3 PARK PL, SWANSEA, IL 62226-2965
(618) 222-9244
(618) 222-9248
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036.132786
IL
208000000X
Pediatrics Physician
2004014306
MO
208000000X
Pediatrics Physician
2007011139
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209903004
—
MO
Enumeration date
02/25/2007
Last updated
10/02/2013
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