Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 14825 | NE |
N | 207QS0010X | Family Doctor - Sports Medicine | 14825 | NE |
NPI | 1104866813 |
---|---|
Provider Name | Bernard Gene Keown |
First Address | Kearney, NE 68845-2909 |
Second Address | Kearney, NE 68845-2909 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 25/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00255 | BCBS OF NEBRASKA (01) | NE |
200084430B | (05) | KS |
8729 | MIDLANDS CHOICE (01) | NE |
B90819 | (02) |