MEDICARE: PETER KEENE TRUE M. D.

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
1	2084P0800X	Psychiatry Physician	0101041893	VA

General Provider Information

NPI Number	:	1073592465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER KEENE TRUE M. D.

Provider Business Mailing Address
First Line	:	2080 CHILD ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32214-5005
Country	:	US
Telephone Number	:	904-542-3473
Fax Number	:	904-542-7662

Provider Business Practice Location Address
First Line	:	2080 CHILD ST
Second Line	:	U. S. NAVAL HOSPITAL JACKSONVILLE NAS JAX
City	:	JACKSONVILLE
State	:	FL
Zip	:	32214-5005
Country	:	US
Telephone Number	:	904-542-3473
Fax Number	:	904-542-7662

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	10/16/2008

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