Provider Demographics
NPI:1356318232
Name:KELLER, THOMAS MCNEESE (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MCNEESE
Last Name:KELLER
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1212 FARMERS LN
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-6747
Mailing Address - Country:US
Mailing Address - Phone:707-528-3374
Mailing Address - Fax:707-528-3201
Practice Address - Street 1:1212 FARMERS LN
Practice Address - Street 2:SUITE 4
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-6747
Practice Address - Country:US
Practice Address - Phone:707-528-3374
Practice Address - Fax:707-528-3201
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG 27288207T00000X
CAG27288208VP0014X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA43302Medicare UPIN
CAOOG272880Medicare PIN