Provider Demographics
NPI:1730122102
Name:KEEVER, CRAIG (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:KEEVER
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 1:5507 W WALSH LN STE 101
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-9007
Mailing Address - Country:US
Mailing Address - Phone:479-544-9432
Mailing Address - Fax:479-544-9443
Practice Address - Street 1:5507 W WALSH LN STE 101
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-9007
Practice Address - Country:US
Practice Address - Phone:479-544-9432
Practice Address - Fax:479-544-9443
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3170208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR146352001Medicaid
ARG10240Medicare UPIN