Clancy, Keith David
Clancy, Keith David is an individual health care provider with primary practice located at 7900 W Jefferson Blvd Ste 306 , Fort Wayne IN 46804-4128. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Surgical Critical Care, Allopathic & Osteopathic Physicians / Trauma Surgery. Allopathic & Osteopathic Physicians / Trauma Surgery is his primary health care specialty. Clancy, Keith David can be contacted via phone (260) 458-3610.Contact Information
Primary practice address
7900 W Jefferson Blvd Ste 306
Fort Wayne IN 46804-4128
Phone: (260) 458-3610
Fax: (260) 458-3611
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | MD067578-L | Pennsylvania |
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 036.090092 | Illinois |
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 35.123491 | Ohio |
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 01079569A | Indiana |
| Allopathic & Osteopathic Physicians / Surgical Critical Care | 2086S0102X | MD067578-L | Pennsylvania |
| Allopathic & Osteopathic Physicians / Surgical Critical Care | 2086S0102X | 35.123491 | Ohio |
| Allopathic & Osteopathic Physicians / Trauma Surgery | 2086S0127X | 036.090092 | Illinois |
| Allopathic & Osteopathic Physicians / Trauma Surgery | 2086S0127X | MD067578-L | Pennsylvania |
| Allopathic & Osteopathic Physicians / Trauma Surgery | 2086S0127X | 35.123491 | Ohio |
| Allopathic & Osteopathic Physicians / Trauma Surgery | 2086S0127X | 01079569A | Indiana |
Profile Details
| NPI number | 1164482303 |
|---|---|
| LBN Legal business name | Clancy, Keith David |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 23rd, 2006 |
| Last updated | Sep 23rd, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1164482303 | NPPES |
| Pennsylvania | MEDICAID | 001757641 | |
| Pennsylvania | Other | 117558 | |
| Pennsylvania | Other | 562564 | |
| Pennsylvania | Other | 039983 | |
| Pennsylvania | Other | 20006031 | |
| Pennsylvania | Other | 7731206 | |
| Pennsylvania | Other | 01122002 | |
| Pennsylvania | Other | 491516 | |
| Pennsylvania | Other | 610201 | |
| Pennsylvania | Other | 1506063 | |
| Pennsylvania | Other | 56845 | |
| Pennsylvania | Other | 0342984000 |
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