IndividualActive
Wade Keller, D.O.
NPI 1942402169 · Dermatology Physician · Eagle, ID
Provider details
- NPI number
- 1942402169
- Entity type
- Individual
- Primary specialty
- Dermatology PhysicianAllopathic & Osteopathic Physicians
- Credential
- D.O.
- Sex
- Male
- Sole proprietor
- No
- License
- 4692 (AZ)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Practice location
1605 E Riverside Dr
Eagle, ID 83616-6237
Phone: (208) 939-6227
Fax: (208) 939-6442
Approximate (ZIP-level) locationGet directions
Mailing address
1605 E Rverside Drive
Eagle, ID 83616
Registry dates
- Enumerated
- 2007-06-01
- Last updated
- 2022-11-03
- Certified
- 2022-11-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.