Healthcare Provider Details

I. General information

NPI: 1932100906
Provider Name (Legal Business Name): ROBERT JAMES KEENAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 04/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12902 USF MAGNOLIA DR MOFFITT CANCER CENTER
TAMPA FL
33612-9416
US

IV. Provider business mailing address

12902 USF MAGNOLIA DR MOFFITT CANCER CENTER
TAMPA FL
33612-9416
US

V. Phone/Fax

Practice location:
  • Phone: 813-745-6080
  • Fax: 813-449-8788
Mailing address:
  • Phone: 813-745-6080
  • Fax: 813-449-8788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD044187E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD044187E
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME 123918
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME 123918
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: