Organization
KELLER DERMATOPATHOLOGY MED GRP INC
Active
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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