Organization
KELLER SKIN & CANCER CARE PC
Active
Organization
KELLER SKIN & CANCER CARE PC
Active
Other names
Keller Skin Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WADE ROBERT KELLER DO (PRESIDENT)
(208) 939-6227
Entity
Organization
Contact information
Practice address
1605 E RIVERSIDE DRIVE, EAGLE, ID 83616
(208) 939-6227
(208) 939-6442
Mailing address
1605 E RIVERSIDE DR, EAGLE, ID 83616-6237
(208) 939-6227
(208) 939-6442
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
O-0559
ID
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
Other
Enumeration date
02/11/2012
Last updated
11/03/2022
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