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NPI Code Detail

MEDICARE: MR. MATTHEW GAIRE KEANE PHYSICIAN ASSISTANT

MEDICARE: MR. MATTHEW GAIRE KEANE PHYSICIAN ASSISTANT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA20525CA

General Provider Information

NPI Number : 1043544778
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MATTHEW GAIRE KEANE PHYSICIAN ASSISTANT
Provider Business Mailing Address
First Line : 2155 E BELLAMY RD
Second Line :
City : PALM SPRINGS
State : CA
Zip : 92262-2522
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 66675 PIERSON BLVD
Second Line :
City : DESERT HOT SPRINGS
State : CA
Zip : 92240-3737
Country : US
Telephone Number : 760-676-5240
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2009
Last Update Date : 04/20/2021

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