Provider Demographics
NPI:1063699163
Name:KEENAN, BRIAN WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:WILLIAM
Last Name:KEENAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1701 LACEY ST
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-5230
Mailing Address - Country:US
Mailing Address - Phone:573-331-6549
Mailing Address - Fax:573-651-5848
Practice Address - Street 1:1701 LACEY ST
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-5230
Practice Address - Country:US
Practice Address - Phone:573-331-6549
Practice Address - Fax:573-651-5848
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2007024787208000000X
LA294252207P00000X
NC2013-01907207P00000X
MO2014037017207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2106856Medicaid