Individual
DR. GREGORY C KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1325 SAN MARCO BLVD STE 200, CREDENTIALING DEPARTMENT, JACKSONVILLE, FL 32207-8566
(904) 346-3465
(904) 399-1537
Mailing address
1325 SAN MARCO BLVD STE 200, JACKSONVILLE, FL 32207-8566
(904) 346-3465
(904) 399-1537
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
ME62258
FL
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
ME62258
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00655069A
—
GA
05
—
376096100
—
FL
Enumeration date
06/09/2005
Last updated
03/25/2021
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