Provider Demographics
NPI:1750365144
Name:KEENAN, CRAIG RAYMOND (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:RAYMOND
Last Name:KEENAN
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 1:4150 V ST
Mailing Address - Street 2:SUITE 2400
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1460
Mailing Address - Country:US
Mailing Address - Phone:916-734-7500
Mailing Address - Fax:916-734-2732
Practice Address - Street 1:4150 V ST
Practice Address - Street 2:SUITE 2400
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1460
Practice Address - Country:US
Practice Address - Phone:916-734-7500
Practice Address - Fax:916-734-2732
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80806207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG24290Medicare UPIN