Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | R8A21 | MO |
NPI | 1023063393 |
---|---|
Provider Name | William Keenan |
First Address | St. Louis, MO 63110-2515 |
Second Address | Saint Louis, MO 63104-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 26/08/2015 |