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General NPI Number Information
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NPI Number | 1003892837
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Entity Type | Individual
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Provider Name | DAVID JOE KEAHEY PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 12/04/2017
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Provider Practice Location Address
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Address Line | 461 S 400 E
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City | SALT LAKE CITY
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State | UT
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Zip | 84111-3302
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Country | US
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Telephone | 801-539-8634
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Fax |
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Provider Business Mailing Address
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Address Line | 1705 E 4620 S
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City | SALT LAKE CITY
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State | UT
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Zip | 84117-5003
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Country | US
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Telephone | 801-277-4192
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 101527-1206
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License Number State | UT
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