MEDICARE: DR. JAMES COOPER KEANE 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	207NS0135X	Procedural Dermatology Physician	MD.205964	LA
2	207NS0135X	Procedural Dermatology Physician	E-6521	AR

General Provider Information

NPI Number	:	1427221704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES COOPER KEANE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 22918
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72221-2918
Country	:	US
Telephone Number	:	501-404-9646
Fax Number	:

Provider Business Practice Location Address
First Line	:	11412 HURON LN
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-1847
Country	:	US
Telephone Number	:	501-404-9646
Fax Number	:

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

Provider Enumeration Date	:	04/08/2008
Last Update Date	:	10/09/2016

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