Provider Demographics
NPI:1194829838
Name:KEANE, PAUL JOSEPH (DPM)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JOSEPH
Last Name:KEANE
Suffix:
Gender:M
Credentials:DPM
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 1730
Mailing Address - Street 2:
Mailing Address - City:BRYSON CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28713-1730
Mailing Address - Country:US
Mailing Address - Phone:828-488-8200
Mailing Address - Fax:828-488-8221
Practice Address - Street 1:267 W RIDGE DR
Practice Address - Street 2:
Practice Address - City:BRYSON CITY
Practice Address - State:NC
Practice Address - Zip Code:28713-7602
Practice Address - Country:US
Practice Address - Phone:828-488-8200
Practice Address - Fax:828-488-8221
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC57213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
225158OtherPARTNERS
0802QOtherBCBS
08153OtherBCBS
NC890802QMedicaid
NC8908153Medicaid
P00102841OtherMEDICARE RR
225158OtherPARTNERS
NC890802QMedicaid