MEDICARE: DR. DENNIS J KEITHLY 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
1	207P00000X	Emergency Medicine Physician	34589	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00650207	OTHER	MO	RAILROAD MEDICARE

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	:	1518069087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS J KEITHLY MD

Provider Business Mailing Address
First Line	:	621 S NEW BALLAS RD
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-8232
Country	:	US
Telephone Number	:	314-251-6816
Fax Number	:

Provider Business Practice Location Address
First Line	:	621 S NEW BALLAS RD
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-8232
Country	:	US
Telephone Number	:	314-251-6816
Fax Number	:

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

Provider Enumeration Date	:	09/03/2006
Last Update Date	:	03/31/2015

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Directions to “ DR. DENNIS J KEITHLY MD” Practice Location

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