MEDICARE: MARY BRIDGET KEEGAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	2010017094	MO

General Provider Information

NPI Number	:	1164733515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY BRIDGET KEEGAN M.D.

Provider Business Mailing Address
First Line	:	1717 BIDDLE ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63106-3454
Country	:	US
Telephone Number	:	314-898-1700
Fax Number	:	314-814-8542

Provider Business Practice Location Address
First Line	:	3930 S BROADWAY
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-4626
Country	:	US
Telephone Number	:	314-898-1700
Fax Number	:	314-814-8542

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2010
Last Update Date	:	10/05/2022

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