Provider Demographics
NPI:1831319383
Name:KELLER, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
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 1:7913 BANDERA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-6511
Mailing Address - Country:US
Mailing Address - Phone:210-698-9841
Mailing Address - Fax:210-698-9863
Practice Address - Street 1:7913 BANDERA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-6511
Practice Address - Country:US
Practice Address - Phone:210-698-9841
Practice Address - Fax:210-698-9863
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6221207R00000X
CAA111086207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8W6315OtherBCBS
TX8K0649Medicare PIN
TX8W6315OtherBCBS