Provider Demographics
NPI:1851602254
Name:JULIE A KEELER DO INC
Entity Type:Organization
Organization Name:JULIE A KEELER DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KEELER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:619-272-4222
Mailing Address - Street 1:771 JAMACHA RD
Mailing Address - Street 2:#257
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-3202
Mailing Address - Country:US
Mailing Address - Phone:619-272-4222
Mailing Address - Fax:619-272-4222
Practice Address - Street 1:771 JAMACHA RD (NO OFFICE - HOUSECALLS ONLY)
Practice Address - Street 2:#257
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-3202
Practice Address - Country:US
Practice Address - Phone:619-272-4222
Practice Address - Fax:619-272-4222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9655207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F95547Medicare UPIN
AN442Medicare PIN