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General NPI Number Information
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NPI Number | 1154518231
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Entity Type | Organization
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Legal Business Name | JACK E. KEISER,JR.,M.D.,PC
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Dates
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Enumeration Date | 10/02/2007
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Last Update Date | 08/07/2013
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Provider Practice Location Address
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Address Line | 50 BROOKHOLLOW DR
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City | AUBURN
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State | NY
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Zip | 13021-9654
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Country | US
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Telephone | 315-252-0200
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Fax |
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Provider Business Mailing Address
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Address Line | 50 BROOKHOLLOW DR
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City | AUBURN
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State | NY
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Zip | 13021-9654
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Country | US
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Telephone | 315-252-0200
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Fax |
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Authorized Official
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Title or Position | CEO/UROLOGIST
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Name | DR. JACK E KEISER JR.
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Credential | M.D.
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Telephone | 315-253-2785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 137461
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License Number State | NY
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