Healthcare Provider Details

I. General information

NPI: 1245591627
Provider Name (Legal Business Name): BRIAN JAY KEEGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2012
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W NORFOLK AVE ATTN:HOSPITALISTS
NORFOLK NE
68701-4438
US

IV. Provider business mailing address

2700 W NORFOLK AVE ATTN:HOSPITALISTS
NORFOLK NE
68701-4438
US

V. Phone/Fax

Practice location:
  • Phone: 402-371-4880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number27495
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: