Provider Demographics
NPI:1073543690
Name:KEENE, ROGER H (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:H
Last Name:KEENE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 450329
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045
Mailing Address - Country:US
Mailing Address - Phone:956-722-9918
Mailing Address - Fax:956-722-0829
Practice Address - Street 1:6801 MCPHERSON AVE
Practice Address - Street 2:SUITE 331
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6417
Practice Address - Country:US
Practice Address - Phone:956-722-9918
Practice Address - Fax:956-722-0829
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD2894207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089809002Medicaid
TX8F9025Medicare PIN
TXC17757Medicare UPIN
TX089809002Medicaid