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Organization

KELLER DERMATOPATHOLOGY MED GRP INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ALBERT R KELLER MD (PRESIDENT)
(510) 663-6204
Entity
Organization

Contact information

Practice address
401 29TH ST, SUITE 109, OAKLAND, CA 94609-3519
(510) 663-6204
Mailing address
PO BOX 282848, SAN FRANCISCO, CA 94128-2848
(650) 616-2948

Taxonomy

Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
CLF11769
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
LAB08537F
CA
01
ZZZ06208Z
BLUE SHIELD
CA
Enumeration date
08/14/2006
Last updated
08/22/2020
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