Provider Demographics
NPI:1649232646
Name:KEEBLE, DONALD S (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:S
Last Name:KEEBLE
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 1:1924 ALCOA HWY # U67
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1511
Mailing Address - Country:US
Mailing Address - Phone:865-305-9350
Mailing Address - Fax:865-305-8681
Practice Address - Street 1:1924 ALCOA HWY # U67
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1511
Practice Address - Country:US
Practice Address - Phone:865-305-9350
Practice Address - Fax:865-305-8681
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16114207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3373352OtherMEDICAID GROUP
TN1689631137OtherGROUP NPI
TN3015044OtherMEDICARE PTAN UFP
TN3015045Medicaid
TN3373352OtherMEDICARE GROUP UFP
TN1689631137OtherGROUP NPI
TN3882883Medicare ID - Type Unspecified