Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 04-31531 | KS |
Y | 207Q00000X | Family Doctor | 04-31531 | KS |
NPI | 1174606826 |
---|---|
Provider Name | Charles R Keener |
First Address | Great Bend, KS 67530 |
Second Address | Great Bend, KS 67530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 02/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I49042 | (02) | KS |