Healthcare Provider Details

I. General information

NPI: 1295012409
Provider Name (Legal Business Name): ROBERT WILLIAM KEATON PA - C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2863 RT 45
ROCK CREEK OH
44084-0298
US

IV. Provider business mailing address

3125 HALLOCK YOUNG RD SW
WARREN OH
44481-9216
US

V. Phone/Fax

Practice location:
  • Phone: 440-563-3400
  • Fax:
Mailing address:
  • Phone: 330-824-3205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2618
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: