Healthcare Provider Details

I. General information

NPI: 1801036868
Provider Name (Legal Business Name): GARY DON KEEL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#1 LOCKHEED BLVD. LOCKHEED MARTIN AERONAUTICS COMPANY
FT. WORTH TX
76108
US

IV. Provider business mailing address

3106 WALNUT CREEK PKWY
GRANBURY TX
76049-7916
US

V. Phone/Fax

Practice location:
  • Phone: 817-777-8183
  • Fax: 817-777-1956
Mailing address:
  • Phone: 817-326-5586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA02112
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: