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NPI Code Detail

MEDICARE: DR. ROBERT NICOLAS KEENAN M.D.

MEDICARE: DR. ROBERT NICOLAS 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
1208600000XSurgery PhysicianA79742CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1YYY49687YOTHERCASOUTHERN BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3ZZZ27707ZOTHERCANORTHERN BLUE SHIELD

General Provider Information

NPI Number : 1558325654
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT NICOLAS KEENAN M.D.
Provider Business Mailing Address
First Line : 1374 S MISSION RD STE 408
Second Line :
City : FALLBROOK
State : CA
Zip : 92028-4006
Country : US
Telephone Number : 951-698-4650
Fax Number : 951-698-4651
Provider Business Practice Location Address
First Line : 1374 S MISSION RD STE 408
Second Line :
City : FALLBROOK
State : CA
Zip : 92028-4006
Country : US
Telephone Number : 951-698-4650
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2006
Last Update Date : 06/15/2023

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