Doctor Name: | BRYAN KEENAN |
NPI Number: | 1033311758 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 0101237249 |
Business Practice Address: | Mag 39 Area 22 Medical, Bldg 22190 Camp Pendleton, CA - 92055 |
Business Phone Number: | 7607252969 |
Business Fax Number: | |
Mailing Address: | 12562 Caminito Mira Del Mar, SAN DIEGO |
State: | CA |
Postal Code: | 921302387 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 06/04/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 0101237249 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |