Organization
STEWART KELLER DO PA
Active
Organization
STEWART KELLER DO PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEWART R KELLER DO (OWNER)
(817) 348-8333
Entity
Organization
Contact information
Practice address
1314 LAKE ST, SUITE 102, FORT WORTH, TX 76102-4581
(817) 348-8333
(817) 348-8415
Mailing address
1314 LAKE ST, SUITE 102, FORT WORTH, TX 76102-4581
(817) 348-8333
(817) 348-8415
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0003QJ
BCBS
TX
05
—
179056001
—
TX
01
—
DE2226
MEDICARE RAILROAD
—
Enumeration date
05/16/2006
Last updated
06/23/2008
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