Provider Demographics
NPI:1053320176
Name:KEIGHLEY, ROBERT D (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:KEIGHLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 S KNOXVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2622
Mailing Address - Country:US
Mailing Address - Phone:419-394-3333
Mailing Address - Fax:419-394-5476
Practice Address - Street 1:829 TIMBERLAKE CT
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-3495
Practice Address - Country:US
Practice Address - Phone:419-236-3315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-003786208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA83134Medicare UPIN
OH0620492Medicare ID - Type Unspecified