Provider Demographics
NPI:1982631131
Name:KELLER, CRISTA C (MD)
Entity Type:Individual
Prefix:
First Name:CRISTA
Middle Name:C
Last Name:KELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CRISTA
Other - Middle Name:C
Other - Last Name:SPEARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-394-9355
Mailing Address - Fax:303-388-8564
Practice Address - Street 1:4500 E 9TH AVE STE 450
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3933
Practice Address - Country:US
Practice Address - Phone:303-394-9355
Practice Address - Fax:303-388-8564
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39823207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO58271040Medicaid
COC811646Medicare PIN
COP00638811Medicare PIN
CO58271040Medicaid