Keaton, Jerry

Keaton, Jerry is an individual health care provider with primary practice located at 700 E Marshall Ave , Longview TX 75601-5580. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Keaton, Jerry can be contacted via phone (903) 315-2072.

Contact Information

Primary practice address
700 E Marshall Ave Longview TX 75601-5580
Phone: (903) 315-2072
Fax: (903) 247-0222
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X J2634 Texas
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 14699 Oklahoma
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 04-19229 Kansas

Profile Details

NPI number 1699731836
LBN Legal business name Keaton, Jerry
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 25th, 2006
Last updated Jul 8th, 2007 - about 17 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699731836 NPPES
Texas MEDICAID 88R991
Texas Other MDJ2634
Texas Other 117915
Texas Other P00048099
Texas Other 012079
Texas Other 88R995

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