Individual
DR. JEFFREY KELLER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(208) 535-4130
(208) 535-4125
Mailing address
2680 CHANNING WAY, SUITE 115, IDAHO FALLS, ID 83404-7517
(208) 535-4130
(208) 535-4125
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
M5386
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
57984
BLUE CROSS
—
Enumeration date
01/11/2006
Last updated
07/08/2007
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