Provider Demographics
NPI:1427050657
Name:KEENAN, JOHN PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
Last Name:KEENAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5312 ROCKPORT WAY
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8639
Mailing Address - Country:US
Mailing Address - Phone:405-844-6483
Mailing Address - Fax:405-844-6483
Practice Address - Street 1:2401 NW 23RD ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-2442
Practice Address - Country:US
Practice Address - Phone:405-522-7176
Practice Address - Fax:405-530-3245
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2010-07-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK20549207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200046330AMedicaid
A39850Medicare UPIN
249341331Medicare ID - Type Unspecified