MEDICARE: DR. RICHARD GEORGE KEIGHTLEY 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	207KA0200X	Allergy Physician	11856	AZ
2	2080P0201X	Pediatric Allergy/Immunology Physician	11856	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0200027	OTHER	AZ	UHC
2	0200027	OTHER	AZ	UNITED HEALTH CARE
3	2572627	OTHER	AZ	AETNA HMO
4	4022160	OTHER	AZ	AETNA PPO
5	1Z2992	OTHER	AZ	HEALTHNET
6	AZ0027920	OTHER	AZ	BCBS

General Provider Information

NPI Number	:	1568460616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD GEORGE KEIGHTLEY M.D.

Provider Business Mailing Address
First Line	:	20940 N TATUM BLVD
Second Line	:	STE 205
City	:	PHOENIX
State	:	AZ
Zip	:	85050-7260
Country	:	US
Telephone Number	:	480-991-1930
Fax Number	:	480-443-8196

Provider Business Practice Location Address
First Line	:	20940 N TATUM BLVD
Second Line	:	STE 205
City	:	PHOENIX
State	:	AZ
Zip	:	85050-7260
Country	:	US
Telephone Number	:	480-991-1930
Fax Number	:	480-443-8196

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	05/09/2017

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