Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN8198 | FL |
NPI | 1114146453 |
---|---|
Provider Name | Dr. Cesar James Keathley |
First Address | Palm Harbor, FL 34683-1805 |
Second Address | Clearwater, FL 33761-3402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 08/07/2007 |