Provider Demographics
NPI:1235247073
Name:KEIZER, PHILIP JOHN JR (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:JOHN
Last Name:KEIZER
Suffix:JR
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 53
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-687-7134
Mailing Address - Fax:541-687-7135
Practice Address - Street 1:1255 HILYARD ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-687-7134
Practice Address - Fax:541-687-7135
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD214302085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD5334RMedicaid
AKMD5333RMedicaid
OR130052Medicaid
WA8390593Medicaid
G74945Medicare UPIN
AKMD5334RMedicaid
ORP00093399Medicare PIN
AKMD5333RMedicaid
AK161118Medicare PIN
OR117703Medicare PIN
OR130052Medicaid
OR11705Medicare PIN