Provider Demographics
NPI:1295759512
Name:KEEN, DAVID ANTHONY (MD, MPH)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ANTHONY
Last Name:KEEN
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 FELI WAY
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-2368
Mailing Address - Country:US
Mailing Address - Phone:850-926-3140
Mailing Address - Fax:850-926-3163
Practice Address - Street 1:41 FELI WAY
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-2368
Practice Address - Country:US
Practice Address - Phone:850-926-3140
Practice Address - Fax:850-926-3163
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48825207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044087601Medicaid
FL044087601Medicaid
FL02525NMedicare PIN