Individual
STEWART R KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5560 MESA SPRINGS DR, FORT WORTH, TX 76123-2120
(817) 348-8333
(817) 348-8415
Mailing address
PO BOX 34629, FORT WORTH, TX 76162-4629
(817) 348-8333
(817) 348-8415
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
J0038
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
096815803
—
TX
01
—
8AJ514
BCBS
TX
01
—
J0038
STATE LICENSE
TX
01
—
P00279334
MEDICARE RR
—
Enumeration date
05/18/2006
Last updated
04/10/2020
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