Provider Demographics
NPI:1306920533
Name:KELLER, BRIDGET JEAN (MD)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:JEAN
Last Name:KELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8374 MARKET ST
Mailing Address - Street 2:# 239
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5137
Mailing Address - Country:US
Mailing Address - Phone:941-379-8830
Mailing Address - Fax:941-379-8859
Practice Address - Street 1:2401 UNIVERSITY PKWY
Practice Address - Street 2:SUITE 204
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2893
Practice Address - Country:US
Practice Address - Phone:941-379-8830
Practice Address - Fax:941-360-0557
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME973132084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAD606YMedicare PIN