Provider Demographics
NPI:1689677817
Name:KELLER, PAUL M (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:KELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2222 S. HARBOR CITY BLVD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901
Mailing Address - Country:US
Mailing Address - Phone:321-768-9914
Mailing Address - Fax:321-953-1893
Practice Address - Street 1:2222 S. HARBOR CITY BLVD
Practice Address - Street 2:SUITE 420
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-768-9914
Practice Address - Fax:321-953-1893
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65934207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL120064400Medicaid
FLRX278OtherMEDICARE HF
FLF87718Medicare UPIN