Provider Demographics
NPI:1356320303
Name:KEENER, JOSEPH KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:KEITH
Last Name:KEENER
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 1:3604 BUSH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7511
Mailing Address - Country:US
Mailing Address - Phone:919-876-7807
Mailing Address - Fax:919-876-8823
Practice Address - Street 1:3604 BUSH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7511
Practice Address - Country:US
Practice Address - Phone:919-876-7807
Practice Address - Fax:919-876-8823
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23576174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8947988Medicaid
NC47988OtherBCBS PROVIDER NUMBER
NCC88532Medicare UPIN
NC8947988Medicaid