Provider Demographics
NPI:1821431727
Name:KEELER, JASON A (DPM)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:A
Last Name:KEELER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 WILLAMETTE FALLS DR
Mailing Address - Street 2:#111
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-4652
Mailing Address - Country:US
Mailing Address - Phone:503-657-1900
Mailing Address - Fax:
Practice Address - Street 1:1880 WILLAMETTE FALLS DR
Practice Address - Street 2:#111
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-4652
Practice Address - Country:US
Practice Address - Phone:503-657-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP175146213ES0103X, 213EP1101X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine