Provider Demographics
NPI:1932100906
Name:KEENAN, ROBERT JAMES (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:KEENAN
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 1:12902 USF MAGNOLIA DR
Mailing Address - Street 2:MOFFITT CANCER CENTER
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-9416
Mailing Address - Country:US
Mailing Address - Phone:813-745-6080
Mailing Address - Fax:813-449-8788
Practice Address - Street 1:12902 USF MAGNOLIA DR
Practice Address - Street 2:MOFFITT CANCER CENTER
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9416
Practice Address - Country:US
Practice Address - Phone:813-745-6080
Practice Address - Fax:813-449-8788
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044187E208600000X, 208G00000X
FLME 123918208G00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0962472Medicaid
WV125606000Medicaid
PA0012900680007Medicaid
PA0012900680007Medicaid
OH0962472Medicaid
PA729146PNLMedicare PIN