Provider Demographics
NPI:1265610141
Name:KEAHEY, ERIC H (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:H
Last Name:KEAHEY
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 1:14300 ORCHARD PKWY
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80023-9206
Mailing Address - Country:US
Mailing Address - Phone:303-430-5560
Mailing Address - Fax:303-430-5565
Practice Address - Street 1:14300 ORCHARD PKWY
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80023-9206
Practice Address - Country:US
Practice Address - Phone:303-430-5560
Practice Address - Fax:303-430-5565
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO51267207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02182530Medicaid
TX195201204Medicaid
TX195201203Medicaid
TXTXB121380Medicare PIN
COCOA107118Medicare PIN
TX195201203Medicaid
CO02182530Medicaid