MEDICARE: KEITH ALEX RASMUSSEN PA

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	363AM0700X	Medical Physician Assistant	1725	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275707408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH ALEX RASMUSSEN PA

Provider Business Mailing Address
First Line	:	605 SW 27TH ST
Second Line	:
City	:	EL RENO
State	:	OK
Zip	:	73036-5928
Country	:	US
Telephone Number	:	405-295-2200
Fax Number	:	405-295-2178

Provider Business Practice Location Address
First Line	:	605 SW 27TH ST
Second Line	:
City	:	EL RENO
State	:	OK
Zip	:	73036-5928
Country	:	US
Telephone Number	:	405-295-2200
Fax Number	:	405-295-2178

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

Provider Enumeration Date	:	04/18/2008
Last Update Date	:	01/12/2016

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Directions to “ KEITH ALEX RASMUSSEN PA” Practice Location

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