Provider Demographics
NPI:1942286729
Name:KEOUGH, GEORGE C (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:C
Last Name:KEOUGH
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 1:123 FOX RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3369
Mailing Address - Country:US
Mailing Address - Phone:865-690-9467
Mailing Address - Fax:865-637-5057
Practice Address - Street 1:123 FOX RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3369
Practice Address - Country:US
Practice Address - Phone:865-690-9467
Practice Address - Fax:865-637-5057
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000035098207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7527158OtherAETNA
TN3862971Medicaid
TN4145097OtherBLUE CROSS BLUE SHIELD
TN7527158OtherAETNA
TN3376258Medicaid