Provider Demographics
NPI:1821051269
Name:KEETON, ROBERT E (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:KEETON
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:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22803-1430
Mailing Address - Country:US
Mailing Address - Phone:540-564-5791
Mailing Address - Fax:540-564-7038
Practice Address - Street 1:120 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:MOUNT JACKSON
Practice Address - State:VA
Practice Address - Zip Code:22842-9417
Practice Address - Country:US
Practice Address - Phone:540-477-3185
Practice Address - Fax:540-477-2666
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051846207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
700010069OtherCIGNA
200312OtherANTHEM/BCBS
VA1000870001OtherDME PROVIDER
080071938OtherRAILROAD MEDICARE
VA41197OtherOPTIMA
08113000000OtherSOUTHERN HEALTH
VA5609305Medicaid
VA41197OtherOPTIMA
080004755Medicare ID - Type Unspecified
VA5609305Medicaid
VA1000870001Medicare PIN