Provider Demographics
NPI:1871759928
Name:KEELER, LEILA M (DO)
Entity type:Individual
Prefix:
First Name:LEILA
Middle Name:M
Last Name:KEELER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LEILA
Other - Middle Name:MAE
Other - Last Name:MONDEJAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3340 WATERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-5250
Mailing Address - Country:US
Mailing Address - Phone:352-589-6005
Mailing Address - Fax:352-589-6012
Practice Address - Street 1:3340 WATERMAN WAY
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5250
Practice Address - Country:US
Practice Address - Phone:352-589-6005
Practice Address - Fax:352-589-6012
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO168285207V00000X
FLOS17373207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology