Provider Demographics
NPI:1164695094
Name:GREGORY R. KEESE, MD INC, A PROFESSION OF MEDICINE
Entity Type:Organization
Organization Name:GREGORY R. KEESE, MD INC, A PROFESSION OF MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:R
Authorized Official - Last Name:KEESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-833-2406
Mailing Address - Street 1:1360 W 6TH ST STE 305
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3577
Mailing Address - Country:US
Mailing Address - Phone:310-833-2406
Mailing Address - Fax:310-519-8936
Practice Address - Street 1:1360 W 6TH ST STE 305
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3577
Practice Address - Country:US
Practice Address - Phone:310-833-2406
Practice Address - Fax:310-519-8936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty