Provider Demographics
NPI:1033154729
Name:KEENE, GLADYS C (MD)
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:C
Last Name:KEENE
Suffix:
Gender:F
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:P.O. BOX 450329
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045
Mailing Address - Country:US
Mailing Address - Phone:956-722-9918
Mailing Address - Fax:956-722-0829
Practice Address - Street 1:6801 MCPHERSON RD
Practice Address - Street 2:SUITE 331
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6417
Practice Address - Country:US
Practice Address - Phone:956-722-9918
Practice Address - Fax:956-722-0829
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD2893207KA0200X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121446201Medicaid
TX121446205Medicaid
TX8F9026Medicare PIN
TX00T820Medicare Oscar/Certification
TXC17758Medicare UPIN