Healthcare Provider Details

I. General information

NPI: 1265431449
Provider Name (Legal Business Name): CHRISTOPHER KEANE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 NE COURTNEY DR
BEND OR
97701-7636
US

IV. Provider business mailing address

2650 NE COURTNEY DR
BEND OR
97701-7636
US

V. Phone/Fax

Practice location:
  • Phone: 541-647-5200
  • Fax: 541-647-5225
Mailing address:
  • Phone: 541-647-5200
  • Fax: 541-647-5225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA75168
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD28678
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: