Provider Demographics
NPI:1215327168
Name:KEENE, LUKE LANCE (SOIDC)
Entity type:Individual
Prefix:MR
First Name:LUKE
Middle Name:LANCE
Last Name:KEENE
Suffix:
Gender:M
Credentials:SOIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3D MSOB
Mailing Address - Street 2:PSC BOX 20073
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28542-0073
Mailing Address - Country:US
Mailing Address - Phone:910-449-9967
Mailing Address - Fax:
Practice Address - Street 1:MARSOC
Practice Address - Street 2:PSC BOX 20073
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28542-0073
Practice Address - Country:US
Practice Address - Phone:910-449-9967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1265997380OtherSOIDC MILITARY