| NPI | 1649543323 |
|---|---|
| Doing Business As | KELLER SKIN CARE |
| Entity Type | Organization |
| Authorized Contact | WADE ROBERT KELLER President 208-939-6227 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207N00000X Dermatology (Licence: ID O-0559) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery | |
| 207NS0135X Dermatology, Procedural Dermatology | |
| Enumeration Date | 2012-02-11 |
| Last Update Date | 2022-11-03 |