Provider Demographics
NPI:1225018393
Name:KEATS, JOEL BENNER (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:BENNER
Last Name:KEATS
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 31399
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0399
Mailing Address - Country:US
Mailing Address - Phone:323-442-7450
Mailing Address - Fax:323-442-7452
Practice Address - Street 1:1520 SAN PABLO ST
Practice Address - Street 2:LOWER LEVEL, SUITE 1600
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5310
Practice Address - Country:US
Practice Address - Phone:323-442-7450
Practice Address - Fax:323-442-7452
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019313E2085R0202X
CAC353442085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A87793Medicare UPIN