MEDICARE: DR. JOHN PAUL KEENAN 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	207W00000X	Ophthalmology Physician	20549	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	:	1427050657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN PAUL KEENAN M.D.

Provider Business Mailing Address
First Line	:	5312 ROCKPORT WAY
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-8639
Country	:	US
Telephone Number	:	405-844-6483
Fax Number	:	405-844-6483

Provider Business Practice Location Address
First Line	:	2401 NW 23RD ST
Second Line	:	SUITE 1A
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-2442
Country	:	US
Telephone Number	:	405-522-7176
Fax Number	:	405-530-3245

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/19/2010

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