Provider Demographics
NPI:1477539591
Name:KEENEY, TAWN I (MD)
Entity Type:Individual
Prefix:MR
First Name:TAWN
Middle Name:I
Last Name:KEENEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:45 549 PLUMERIA STREET
Mailing Address - Street 2:HAMAKUA HEALTH CENTER INC
Mailing Address - City:HONOKAA
Mailing Address - State:HI
Mailing Address - Zip Code:96727-6902
Mailing Address - Country:US
Mailing Address - Phone:808-775-7204
Mailing Address - Fax:808-775-9404
Practice Address - Street 1:45 549 PLUMERIA STREET
Practice Address - Street 2:HAMAKUA HEALTH CENTER INC
Practice Address - City:HONOKAA
Practice Address - State:HI
Practice Address - Zip Code:96727-6902
Practice Address - Country:US
Practice Address - Phone:808-775-7204
Practice Address - Fax:808-775-9404
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD 2956207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI51864901Medicaid
HI51864901Medicaid
121813Medicare ID - Type UnspecifiedFOHC
0000BDGJKMedicare ID - Type Unspecified