Provider Demographics
NPI:1285094482
Name:KEITHLER, ANDREA N (DO)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:N
Last Name:KEITHLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:DORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 N 1900 E RM 4A100
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0002
Mailing Address - Country:US
Mailing Address - Phone:801-581-2121
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:SAN ANTONIO MILITARY MEDICAL CENTER, MCHE-ZDM-M
Practice Address - City:JBSA FT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-292-5077
Practice Address - Fax:210-292-7868
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1807208D00000X
UT13364109-1204207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice