Provider Demographics
NPI:1851371587
Name:KELLER, GARY (DPM)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:KELLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:8200 NW 27 ST
Mailing Address - Street 2:STE 108
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1906
Mailing Address - Country:US
Mailing Address - Phone:786-662-3893
Mailing Address - Fax:786-662-3899
Practice Address - Street 1:777 E 25TH ST
Practice Address - Street 2:SUITE 112
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3804
Practice Address - Country:US
Practice Address - Phone:305-696-3444
Practice Address - Fax:305-693-6656
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO2364213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390168800Medicaid
FL390168800Medicaid
FL65328Medicare PIN