Provider Demographics
NPI:1184790164
Name:KEENE, MATTHEW S (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:S
Last Name:KEENE
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:12409 W INDIAN SCHOOL RD
Mailing Address - Street 2:C-306
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-9502
Mailing Address - Country:US
Mailing Address - Phone:623-777-9970
Mailing Address - Fax:888-420-4978
Practice Address - Street 1:12409 W INDIAN SCHOOL RD
Practice Address - Street 2:C-306
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-9502
Practice Address - Country:US
Practice Address - Phone:623-777-9970
Practice Address - Fax:888-420-4978
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2013-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ230832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0871440OtherBCBS OF AZ
AZAZ0871440OtherBCBS OF AZ
AZ67092Medicare ID - Type Unspecified