Provider Demographics
NPI:1669596201
Name:KELLER, FERNANDO A
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:A
Last Name:KELLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2623 S SEACREST BLVD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7501
Mailing Address - Country:US
Mailing Address - Phone:561-731-2269
Mailing Address - Fax:531-731-2594
Practice Address - Street 1:2623 S SEACREST BLVD
Practice Address - Street 2:SUITE 214
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7501
Practice Address - Country:US
Practice Address - Phone:561-731-2269
Practice Address - Fax:531-731-2594
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41684207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07554OtherBCBS
FL035344200Medicaid
FL035344200Medicaid
FL07554ZMedicare ID - Type Unspecified
FL07554XMedicare PIN