Provider Demographics
NPI:1487689857
Name:KELLER, RONALD W (DO)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:W
Last Name:KELLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 132
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:MO
Mailing Address - Zip Code:63555-9766
Mailing Address - Country:US
Mailing Address - Phone:660-945-3972
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 53
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:MO
Practice Address - Zip Code:63555-9767
Practice Address - Country:US
Practice Address - Phone:660-465-8511
Practice Address - Fax:660-465-8511
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4C33207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine