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General NPI Number Information
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NPI Number | 1801036868
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Entity Type | Individual
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Provider Name | GARY DON KEEL PA-C
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Gender | Male
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Dates
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Enumeration Date | 03/03/2009
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Last Update Date | 03/04/2009
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Provider Practice Location Address
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Address Line | #1 LOCKHEED BLVD. LOCKHEED MARTIN AERONAUTICS COMPANY
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City | FT. WORTH
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State | TX
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Zip | 76108
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Country | US
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Telephone | 817-777-8183
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Fax | 817-777-1956
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Provider Business Mailing Address
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Address Line | 3106 WALNUT CREEK PKWY
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City | GRANBURY
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State | TX
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Zip | 76049-7916
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Country | US
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Telephone | 817-326-5586
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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 | PA02112
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License Number State | TX
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