Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | D2894 | TX |
NPI | 1073543690 |
---|---|
Provider Name | Roger H Keene |
First Address | Laredo, TX 78045 |
Second Address | Laredo, TX 78041-6417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 19/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
089809002 | (05) | TX |
C17757 | (02) | TX |