Provider Demographics
NPI:1770605172
Name:KEELING, JONATHAN LEE (DO)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:LEE
Last Name:KEELING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N EAGLE CREEK DR
Mailing Address - Street 2:STE 360
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1827
Mailing Address - Country:US
Mailing Address - Phone:859-258-5270
Mailing Address - Fax:859-258-5202
Practice Address - Street 1:120 N EAGLE CREEK DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1827
Practice Address - Country:US
Practice Address - Phone:859-258-5270
Practice Address - Fax:859-258-5202
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9677207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11858020OtherCAQH ID
FL000076700Medicaid
FL000076700Medicaid
KY0169Medicare PIN