Provider Demographics
NPI:1992817175
Name:KELLER, CARY S (MD)
Entity type:Individual
Prefix:DR
First Name:CARY
Middle Name:S
Last Name:KELLER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1919 LATHROP ST
Mailing Address - Street 2:STE 105
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-5937
Mailing Address - Country:US
Mailing Address - Phone:907-451-6561
Mailing Address - Fax:907-451-4847
Practice Address - Street 1:751 OLD RICHARDSON HWY
Practice Address - Street 2:STE# 200
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7813
Practice Address - Country:US
Practice Address - Phone:907-451-6561
Practice Address - Fax:907-451-4847
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2017-11-21
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Provider Licenses
StateLicense IDTaxonomies
AKAA3013207X00000X
AKAA 3013207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD9953Medicaid
AKMD9953Medicaid
AKC97134Medicare UPIN