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General NPI Number Information
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NPI Number | 1295939114
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Entity Type | Organization
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Legal Business Name | CAPE FAMILY PRACTICE, PC
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1417 N MOUNT AUBURN RD
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63701-2171
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Country | US
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Telephone | 573-334-6053
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Fax | 573-334-7855
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Provider Business Mailing Address
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Address Line | 1417 N MOUNT AUBURN RD
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63701-2171
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Country | US
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Telephone | 573-334-6053
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Fax | 573-334-7855
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Authorized Official
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Title or Position | OWNER
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Name | ANTHONY J KEELE
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Credential | MD
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Telephone | 573-334-6053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2002008827
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License Number State | MO
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