Provider Demographics
NPI:1154434306
Name:KEAGLE, JENNIFER NEWMAN (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:NEWMAN
Last Name:KEAGLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 ARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-3988
Mailing Address - Country:US
Mailing Address - Phone:213-250-1300
Mailing Address - Fax:
Practice Address - Street 1:2614 ARTHUR ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-3988
Practice Address - Country:US
Practice Address - Phone:213-250-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA647732086S0122X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A647730OtherMEDICAL PPIN #
CAI33957Medicare UPIN
CAWA64773AMedicare ID - Type UnspecifiedPPIN #