Provider Demographics
NPI:1073732624
Name:KETOVER, ALAN KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:KENNETH
Last Name:KETOVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10595 N TATUM BLVD
Mailing Address - Street 2:SUITE E-146
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-1071
Mailing Address - Country:US
Mailing Address - Phone:602-381-0800
Mailing Address - Fax:602-381-0054
Practice Address - Street 1:10595 N TATUM BLVD
Practice Address - Street 2:SUITE E-146
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-1071
Practice Address - Country:US
Practice Address - Phone:602-381-0800
Practice Address - Fax:602-381-0054
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAZ133792083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine