Provider Demographics
NPI:1891736930
Name:BARON, KEESAG A (MD)
Entity Type:Individual
Prefix:DR
First Name:KEESAG
Middle Name:A
Last Name:BARON
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 1:1242 E. INDEPENDENCE, STE. 200
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4284
Mailing Address - Country:US
Mailing Address - Phone:417-883-5500
Mailing Address - Fax:417-883-5577
Practice Address - Street 1:1242 E. INDEPENDENCE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4284
Practice Address - Country:US
Practice Address - Phone:417-883-5500
Practice Address - Fax:417-883-5577
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107583207RI0011X, 207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO25634OtherBC
MO507022101Medicaid
MO208048512Medicaid
MO909395531OtherMEDICARE ID
25634OtherBLUE CROSS/BLUE SHIELD
MO208048512Medicaid