Provider Demographics
NPI:1700849114
Name:KELLER, JOHN JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JEFFREY
Last Name:KELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4437 STATE ROUTE 159 STE 125
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-7065
Mailing Address - Country:US
Mailing Address - Phone:740-779-4570
Mailing Address - Fax:740-779-4579
Practice Address - Street 1:4437 STATE ROUTE 159
Practice Address - Street 2:SUITE 125
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-7065
Practice Address - Country:US
Practice Address - Phone:740-779-4570
Practice Address - Fax:740-779-4579
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076888207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000000362661OtherANTHEM BCBS
OH2592001Medicaid
P00236852OtherRAILROAD MEDICARE
2504684OtherUNITED HEALTHCARE
130671OtherNATIONWIDE
2504684OtherUNITED HEALTHCARE
KE4158731Medicare ID - Type Unspecified
OH2592001Medicaid