MEDICARE: PAUL WARREN KEISER D.O.

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	207Q00000X	Family Medicine Physician	34-00-3533	OH
2	207Q00000X	Family Medicine Physician	1964	AZ

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	:	1982691994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL WARREN KEISER D.O.

Provider Business Mailing Address
First Line	:	13640 N PLAZA DEL RIO BLVD
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85381-4846
Country	:	US
Telephone Number	:	623-876-3800
Fax Number	:	623-583-5117

Provider Business Practice Location Address
First Line	:	14416 W MEEKER BLVD
Second Line	:	BLDG C
City	:	SUN CITY WEST
State	:	AZ
Zip	:	85375-5284
Country	:	US
Telephone Number	:	623-583-5271
Fax Number	:	623-583-5117

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	01/31/2008

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