Provider Demographics
NPI:1568497139
Name:KEEPERS, JERRY MAY (MD)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:MAY
Last Name:KEEPERS
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 1:308 W PARKWOOD AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-5478
Mailing Address - Country:US
Mailing Address - Phone:713-943-7246
Mailing Address - Fax:713-943-0167
Practice Address - Street 1:308 W PARKWOOD AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5478
Practice Address - Country:US
Practice Address - Phone:713-943-7246
Practice Address - Fax:713-943-0167
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1453174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131836207Medicaid
TX050028204OtherPALMETTO GBA
TX8G3129OtherBLUE CROSS BLUE SHIELD
TXC95103Medicare UPIN
TX8G3129OtherBLUE CROSS BLUE SHIELD