Provider Demographics
NPI:1750325429
Name:KEATING, JEROME PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:PATRICK
Last Name:KEATING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2351 CONNECTICUT AVE S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-2477
Mailing Address - Country:US
Mailing Address - Phone:320-259-1411
Mailing Address - Fax:320-259-8967
Practice Address - Street 1:2351 CONNECTICUT AVE S
Practice Address - Street 2:SUITE 200
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2477
Practice Address - Country:US
Practice Address - Phone:320-259-1411
Practice Address - Fax:320-259-8967
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN29288208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN340003490OtherRAILROAD MEDICARE
MN466200800Medicaid
E45484Medicare UPIN
MN349000134Medicare ID - Type Unspecified