Provider Demographics
NPI:1265609929
Name:KELLER, MERLE L III (MD)
Entity type:Individual
Prefix:
First Name:MERLE
Middle Name:L
Last Name:KELLER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3340 EAST GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-302-7100
Mailing Address - Fax:208-302-7155
Practice Address - Street 1:315 E. ELM STE 100
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605
Practice Address - Country:US
Practice Address - Phone:208-302-7100
Practice Address - Fax:208-302-7155
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT6851459-1205208000000X
IDM-11412208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics