Provider Demographics
NPI:1922727478
Name:ROURKE, KEITH FRANCIS (MD, FRCSC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:FRANCIS
Last Name:ROURKE
Suffix:
Gender:M
Credentials:MD, FRCSC
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Other - Credentials:
Mailing Address - Street 1:14346 PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:EDMONTON
Mailing Address - State:ALBERTA
Mailing Address - Zip Code:T5R5V2
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11234 ANDERSON ST RM A560
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2804
Practice Address - Country:US
Practice Address - Phone:877-558-6248
Practice Address - Fax:909-558-4806
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA2064463208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101232774OtherVIRGINIA BOARD OF MEDICINE