Provider Demographics
NPI:1902873110
Name:KEOWN, RICHARD COULBOURN (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:COULBOURN
Last Name:KEOWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6442 COMMERCE PARK DR
Mailing Address - Street 2:STE 2
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912
Mailing Address - Country:US
Mailing Address - Phone:239-225-2213
Mailing Address - Fax:239-225-2214
Practice Address - Street 1:6442 COMMERCE PARK DR
Practice Address - Street 2:STE 2
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912
Practice Address - Country:US
Practice Address - Phone:239-225-2213
Practice Address - Fax:239-225-2214
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME00346422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
D62326Medicare UPIN
FL36266Medicare ID - Type Unspecified