Provider Demographics
NPI:1124061056
Name:KEUHN, DAVID J (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:KEUHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 N JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-2148
Mailing Address - Country:US
Mailing Address - Phone:660-831-1175
Mailing Address - Fax:660-831-1195
Practice Address - Street 1:2303 S HIGHWAY 65 STE A
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-3735
Practice Address - Country:US
Practice Address - Phone:660-831-1175
Practice Address - Fax:660-831-1195
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001006204208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205316508Medicaid
MOY33A986Medicare Oscar/Certification
MOH07095Medicare UPIN
MO277A986Medicare ID - Type Unspecified