Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 1373 | TX |
N | 222Z00000X | Podiatrist | 1373 | TX |
Y | 224P00000X | Prosthetist | 1373 | TX |
NPI | 1255562294 |
---|---|
Provider Name | Michael D Keown |
First Address | Tyler, TX 75701-3523 |
Second Address | Tyler, TX 75701-3523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2009 |
Last Update Date | 06/08/2009 |