Provider Demographics
NPI:1134323629
Name:KEEGAN, LEE (MD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:KEEGAN
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:PO BOX 52001
Mailing Address - Street 2:DEPT 923
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85072-2001
Mailing Address - Country:US
Mailing Address - Phone:512-336-2777
Mailing Address - Fax:512-336-2778
Practice Address - Street 1:345 CYPRESS CREEK RD
Practice Address - Street 2:STE 104
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4483
Practice Address - Country:US
Practice Address - Phone:512-336-2777
Practice Address - Fax:512-336-2778
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN6897208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX214041001Medicaid
TXB105875Medicare PIN