KELLER SKIN & CANCER CARE PC (NPI# 1649543323) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649543323 |
| Entity Type | Organization |
| Organization Name | KELLER SKIN & CANCER CARE PC |
| Other Organization Name | KELLER SKIN CARE |
| Practice Address |
1605 E Riverside Drive Eagle ID 83616 |
| Mailing Address |
1605 E Riverside Dr Eagle ID 83616-6237 |
| Practice Telephone | (208) 939-6227 |
| Practice Fax Number | 2089396442 |
| Mailing Telephone | 2089396227 |
| Mailing Fax Number | 2089396442 |
| Enumeration Date | 2012-02-11 |
| Last Update Date | 2020-02-12 |
| Authorized Official Name | DR. WADE ROBERT KELLER (PRESIDENT) |
| Authorized Official Telephone | 2089396227 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | O-0559 | ID | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Keller Skin Care | Doing Business As Name - Organization |
| Street Address |
1605 E RIVERSIDE DRIVE |
| City | EAGLE |
| State | ID |
| Zip Code | 83616 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215936034 | Heather Nicole Knutson | Nurse Practitioner | 1605 E Riverside Drive, Eagle, ID 83616-6237 | 2005-07-14 |
| 1538276928 | Angela Ann Coyne | Physician Assistant | 1605 E Riverside Drive, Eagle, ID 83616-6237 | 2006-08-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730714049 | Care Medical Housecalls PC | Nurse Practitioner | 2040 E Holgate Ct, Eagle, ID 83616 | 2020-03-06 |
| 1629613823 | Counseling Solutions Center LLC | Marriage & Family Therapist | 2618 East Snocreek, Eagle, ID 83616 | 2019-11-12 |
| 1245726918 | Tracy Lyn Hagadorn | Midwife | 182 State Street, Eagle, ID 83616 | 2018-07-06 |
| 1861922627 | Nicholas A. Stelzner | Counselor | 2419 W. State St. Suite 8, Boise, ID 83616 | 2017-06-14 |
| 1184080210 | Gabriel Guerrero | Dermatology | 323 E Riverside Dr Ste 234, Eagle, ID 83616 | 2016-01-05 |
| 1376940668 | Cecilia Jo Hickam | Dental Hygienist | 1121 E. State Street, Suite - 102-d, Eagle, ID 83616 | 2014-12-02 |
| 1871912634 | Christine E Birch | Psychiatry & Neurology | 1032 S Bridgeway Pl Ste 110, Eagle, ID 83616 | 2014-04-09 |
| 1043552524 | Tori Croshaw | Social Worker | 372 S Eagle Rd Ste 190, Eagle, ID 83616 | 2013-03-21 |
| 1053650010 | Kellie Ann Northam | Nurse Practitioner | 192 West State Street, Eagle, ID 83616 | 2013-02-11 |
| 1437494457 | Mary Beth Roehling | Nurse Practitioner | 2040 E Hologate Ct, Eagle, ID 83616 | 2012-12-03 |
| Find all providers in zip 83616 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184080210 | Gabriel Guerrero | Dermatology | 323 E Riverside Dr Ste 234, Eagle, ID 83616 | 2016-01-05 |
| 1942402169 | Wade Robert Keller | Dermatology | 1605 E Riverside Dr, Eagle, ID 83616-6237 | 2007-06-01 |
| 1699866822 | Gregory Lynn Flint | Dermatology | 868 E Riverside Dr, Suite 200, Eagle, ID 83616-6019 | 2006-09-26 |
| 1215553409 | Colorado Mountain Medical, LLC | Dermatology | 377 Sylvan Lake Road, Suite 210, Eagle, CO 81631 | 2020-06-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356942437 | Stoddard & Bingham Medical of Rexburg Pllc | Dermatology | 859 S Yellowstone Hwy Ste 3302, Rexburg, ID 83440-6200 | 2020-11-04 |
| 1508345091 | Integrated Dermatology of Idaho LLC | Dermatology | 388 E Parkcenter Blvd, Boise, ID 83706-3942 | 2018-08-07 |
| 1306209556 | Garrett Coman | Dermatology | St. Luke's Dermatology, 191 5th Street West, Ketchum, ID 83340 | 2016-04-04 |
| 1104220797 | Boise Skin Clinic Pllc | Dermatology | 1636 S Hadley Ave, Boise, ID 83709-2684 | 2014-10-10 |
| 1164834073 | Colby Bingham | Dermatology | 1344 Hiland Ave Ste D, Burley, ID 83318-1564 | 2014-05-27 |
| 1699194530 | Dustin Larsen | Dermatology | 2199 N Merrit Crk Loop, Coeur D Alene, ID 83814-4949 | 2014-04-08 |
| 1265795660 | Richard Scott Thomas | Dermatology | 4664 N Penngrove Way Ste 100, Meridian, ID 83646-7442 | 2012-06-20 |
| 1316216369 | Ashley Anne Hamstra | Dermatology | 421 E Lakeside Ave Ste 105, Coeur D Alene, ID 83814-2848 | 2011-12-20 |
| 1487899365 | Jaclyn Golus Mentzer | Dermatology | 388 E. Parkcenter Blvd. Gem State Dermatology, Boise, ID 83706 | 2008-12-08 |
| 1013170125 | Benjamin Carl Ringger | Dermatology | 2288 N Merritt Creek Loop, Coeur D Alene, ID 83814-4959 | 2008-07-08 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.