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General NPI Number Information
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NPI Number | 1659482420
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Entity Type | Individual
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Provider Name | MARY ANNE KEGLEY MD
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 05/08/2014
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Provider Practice Location Address
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Address Line | 4492 GRANGER ST AESCLEPIUS -MARY ANNE KEGLEY MD INC
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City | SAN DIEGO
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State | CA
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Zip | 92107
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Country | US
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Telephone | 276-608-1314
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Fax |
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Provider Business Mailing Address
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Address Line | 275 N EL CIELO RD STE 402D DESERT OASIS HEALTHCARE
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City | PALM SPRINGS
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State | CA
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Zip | 92262-6972
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Country | US
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Telephone | 760-320-8814
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101048930
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G87180
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License Number State | CA
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