Healthcare Provider Details

I. General information

NPI: 1104866813
Provider Name (Legal Business Name): BERNARD GENE KEOWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 W 35TH ST
KEARNEY NE
68845-2909
US

IV. Provider business mailing address

2810 W 35TH ST
KEARNEY NE
68845-2909
US

V. Phone/Fax

Practice location:
  • Phone: 308-865-2570
  • Fax: 308-865-2508
Mailing address:
  • Phone: 308-865-2570
  • Fax: 308-865-2508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number14825
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14825
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: