Provider Demographics
NPI:1942230032
Name:KEENE, JAMES ROLAND (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROLAND
Last Name:KEENE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 DALTON LN
Mailing Address - Street 2:
Mailing Address - City:ZILLAH
Mailing Address - State:WA
Mailing Address - Zip Code:98953-9300
Mailing Address - Country:US
Mailing Address - Phone:509-961-5352
Mailing Address - Fax:
Practice Address - Street 1:5219 W CLEARWATER AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1914
Practice Address - Country:US
Practice Address - Phone:509-783-3744
Practice Address - Fax:509-736-0771
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001639208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice