Provider Demographics
NPI:1619970217
Name:KEILL, RALPH (MD)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:KEILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2300
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93902-2300
Mailing Address - Country:US
Mailing Address - Phone:831-622-8400
Mailing Address - Fax:
Practice Address - Street 1:5 WOODSIDE PL
Practice Address - Street 2:
Practice Address - City:CARMEL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93924-9545
Practice Address - Country:US
Practice Address - Phone:831-659-5124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC27407208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA33364Medicare UPIN
CA00C274070Medicare ID - Type Unspecified