Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | MD0000018511 | TN |
NPI | 1043395122 |
---|---|
Provider Name | Jeffrey A Keenan |
First Address | Knoxville, TN 37934 |
Second Address | Knoxville, TN 37934 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 29/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3058073 | (05) | TN |
E74187 | (02) | TN |