Provider Demographics
NPI:1801038914
Name:KELLERSHABROKH, JAMES (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:KELLERSHABROKH
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 1:3811 E BELL RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2138
Mailing Address - Country:US
Mailing Address - Phone:602-971-8200
Mailing Address - Fax:602-971-8201
Practice Address - Street 1:3811 E BELL RD
Practice Address - Street 2:SUITE 207
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2138
Practice Address - Country:US
Practice Address - Phone:602-971-8200
Practice Address - Fax:602-971-8201
Is Sole Proprietor?:No
Enumeration Date:2009-04-03
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.131970208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation