Individual
JIM E KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
115 15TH AVE, IDAHO SPRINGS, CO 80452
(303) 567-2668
Mailing address
10251 PENNINGTON LN, HIGHLANDS RANCH, CO 80126-5584
(303) 346-5412
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2055
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08576840
—
CO
Enumeration date
11/21/2006
Last updated
02/05/2008
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