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General NPI Number Information
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NPI Number | 1902873110
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Entity Type | Individual
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Provider Name | RICHARD COULBOURN KEOWN MD
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Gender | Male
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Dates
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Enumeration Date | 03/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6442 COMMERCE PARK DR STE 2
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City | FORT MYERS
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State | FL
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Zip | 33912
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Country | US
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Telephone | 239-225-2213
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Fax | 239-225-2214
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Provider Business Mailing Address
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Address Line | 6442 COMMERCE PARK DR STE 2
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City | FORT MYERS
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State | FL
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Zip | 33912
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Country | US
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Telephone | 239-225-2213
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Fax | 239-225-2214
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME0034642
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License Number State | FL
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