Provider Demographics
NPI:1386636413
Name:KEENER, GERALD JR (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:KEENER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1400 N RITTER AVE
Mailing Address - Street 2:STE 276
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-3052
Mailing Address - Country:US
Mailing Address - Phone:317-352-1841
Mailing Address - Fax:317-352-0097
Practice Address - Street 1:1400 N RITTER AVE
Practice Address - Street 2:STE 276
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3052
Practice Address - Country:US
Practice Address - Phone:317-352-1841
Practice Address - Fax:317-352-0097
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN010-22214207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA100055680Medicaid
IA100055680Medicaid
IN060530Medicare PIN