Provider Demographics
NPI:1790779577
Name:KEOGH, GARY J (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:J
Last Name:KEOGH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4619 SPRING HILL AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-5709
Mailing Address - Country:US
Mailing Address - Phone:251-633-7211
Mailing Address - Fax:251-410-6079
Practice Address - Street 1:3715 HIGHWAY 280-431 NORTH
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867
Practice Address - Country:US
Practice Address - Phone:251-633-7211
Practice Address - Fax:251-410-6079
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2019-09-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL246562081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051005486OtherBCBS
ALF36861Medicare UPIN
AL051559064Medicare PIN