Individual
GREG S KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3195 STILLWATER DR STE D, PRESCOTT, AZ 86305-7171
(928) 708-4545
(928) 708-4544
Mailing address
PO BOX 10880, PRESCOTT, AZ 86304-0880
(928) 759-5874
(928) 458-2039
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
31711
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31711
MEDICAL LICENSE
AZ
05
—
496291
—
AZ
Enumeration date
08/20/2006
Last updated
12/01/2021
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