Healthcare Provider Details

I. General information

NPI: 1619111200
Provider Name (Legal Business Name): CHRISTOPHER KEEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S INGLESIDE ST
FAIRHOPE AL
36532-1803
US

IV. Provider business mailing address

150 S INGLESIDE ST
FAIRHOPE AL
36532-1803
US

V. Phone/Fax

Practice location:
  • Phone: 251-660-5930
  • Fax: 516-605-9312
Mailing address:
  • Phone: 251-660-5930
  • Fax: 516-605-9312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number1637
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number2644
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: