Provider Demographics
NPI:1407175425
Name:KEEN, STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:KEEN
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 1:461 S NOVA RD
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-6138
Mailing Address - Country:US
Mailing Address - Phone:386-671-4337
Mailing Address - Fax:386-676-7193
Practice Address - Street 1:461 S NOVA RD
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-6138
Practice Address - Country:US
Practice Address - Phone:386-671-4337
Practice Address - Fax:386-676-7193
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME110991OtherMEDICAL LICENSE
FLME110991OtherMEDICAL LICENSE
FL004610000Medicaid
FLME110991OtherMEDICAL LICENSE
FL1407175425OtherTRICARE