Provider Demographics
NPI:1265431449
Name:KEANE, CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:KEANE
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 1:2650 NE COURTNEY DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7636
Mailing Address - Country:US
Mailing Address - Phone:541-647-5200
Mailing Address - Fax:541-647-5225
Practice Address - Street 1:2650 NE COURTNEY DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7636
Practice Address - Country:US
Practice Address - Phone:541-647-5200
Practice Address - Fax:541-647-5225
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75168207Q00000X
ORMD28678207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR273855Medicaid
H64009Medicare UPIN
OR273855Medicaid