Provider Demographics
NPI:1750443271
Name:KELLER, JOLAN CSUS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOLAN
Middle Name:CSUS
Last Name:KELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7245 RIVER FOREST LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-2612
Mailing Address - Country:US
Mailing Address - Phone:813-541-1575
Mailing Address - Fax:813-436-9593
Practice Address - Street 1:3800 CITIGROUP CENTER
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610
Practice Address - Country:US
Practice Address - Phone:813-604-4336
Practice Address - Fax:813-604-4337
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME815802083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine