Provider Demographics
NPI:1629352232
Name:KEETER, JOE PORTER
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:PORTER
Last Name:KEETER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 PEACH
Mailing Address - Street 2:
Mailing Address - City:WAURKIA
Mailing Address - State:OK
Mailing Address - Zip Code:73573
Mailing Address - Country:US
Mailing Address - Phone:580-228-2766
Mailing Address - Fax:
Practice Address - Street 1:1100 N HWY 81
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533
Practice Address - Country:US
Practice Address - Phone:580-252-2375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist