Provider Demographics
NPI:1700845195
Name:KELLER, ALEXANDER P IV (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:P
Last Name:KELLER
Suffix:IV
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 1:5519 COTTONROSE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45431-1579
Mailing Address - Country:US
Mailing Address - Phone:706-714-6878
Mailing Address - Fax:
Practice Address - Street 1:88 MDG/SGH
Practice Address - Street 2:
Practice Address - City:WRIGHT-PATTERSON AFB
Practice Address - State:OH
Practice Address - Zip Code:45433
Practice Address - Country:US
Practice Address - Phone:937-938-2758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS7471171000000X, 207PE0004X
GA058258207P00000X, 2083A0100X
OH35.150633207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No171000000XOther Service ProvidersMilitary Health Care Provider
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine