Provider Demographics
NPI:1811029804
Name:KEATING, KEITH MARION (DO)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:MARION
Last Name:KEATING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3607 CROSSINGS DR STE B
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7149
Mailing Address - Country:US
Mailing Address - Phone:928-775-2083
Mailing Address - Fax:928-775-3047
Practice Address - Street 1:3607 CROSSINGS DR STE B
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7149
Practice Address - Country:US
Practice Address - Phone:928-775-2083
Practice Address - Fax:928-775-3047
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2013-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ1877207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ69845Medicare ID - Type Unspecified
AZE45425Medicare UPIN