Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 11856 | AZ |
N | 2080P0201X | Pediatric Allergist | 11856 | AZ |
NPI | 1568460616 |
---|---|
Provider Name | Dr. Richard George Keightley |
First Address | Phoenix, AZ 85050-7260 |
Second Address | Phoenix, AZ 85050-7260 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 09/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0200027 | UHC (01) | AZ |
0200027 | UNITED HEALTH CARE (01) | AZ |
1Z2992 | HEALTHNET (01) | AZ |
2572627 | AETNA HMO (01) | AZ |
4022160 | AETNA PPO (01) | AZ |
AZ0027920 | BCBS (01) | AZ |
E49914 | (02) | AZ |
Z200292 | (02) | AZ |