Healthcare Provider Details

I. General information

NPI: 1598973851
Provider Name (Legal Business Name): PHILIP EARL KEEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 DIVISION ST
PRESCOTT AZ
86301-1604
US

IV. Provider business mailing address

4060 W GRANDVIEW RD
PHOENIX AZ
85053-2731
US

V. Phone/Fax

Practice location:
  • Phone: 928-771-3163
  • Fax: 928-771-3105
Mailing address:
  • Phone: 602-843-5205
  • Fax: 602-547-9337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number7417
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: