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NPI Code Detail

MEDICARE: JOEL BENNER KEATS MD

MEDICARE:   JOEL BENNER KEATS  MD
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
12085R0202XDiagnostic Radiology PhysicianMD019313EPA
22085R0202XDiagnostic Radiology PhysicianC35344CA

General Provider Information

NPI Number : 1225018393
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOEL BENNER KEATS MD
Provider Business Mailing Address
First Line : PO BOX 31399
Second Line :
City : LOS ANGELES
State : CA
Zip : 90031-0399
Country : US
Telephone Number : 323-442-7450
Fax Number : 323-442-7452
Provider Business Practice Location Address
First Line : 1520 SAN PABLO ST
Second Line : LOWER LEVEL, SUITE 1600
City : LOS ANGELES
State : CA
Zip : 90033-5310
Country : US
Telephone Number : 323-442-7450
Fax Number : 323-442-7452
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2006
Last Update Date : 04/26/2012

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Directions to “ JOEL BENNER KEATS MD” Practice Location

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