Individual
DR. WADE ROBERT KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1605 E RIVERSIDE DR, EAGLE, ID 83616-6237
(208) 939-6227
(208) 939-6442
Mailing address
1605 E RVERSIDE DRIVE, EAGLE, ID 83616
(208) 939-6227
(208) 939-6442
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
4692
AZ
207N00000X
Dermatology Physician
Primary
O-0559
ID
207ND0101X
MOHS-Micrographic Surgery Physician
O-0559
ID
207NS0135X
Procedural Dermatology Physician
O-0559
ID
Other
Enumeration date
06/01/2007
Last updated
11/03/2022
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