Provider Demographics
NPI:1811533805
Name:PATRICK KEEHAN DO PA
Entity type:Organization
Organization Name:PATRICK KEEHAN DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:415-802-1310
Mailing Address - Street 1:6387 CAMP BOWIE BLVD STE B
Mailing Address - Street 2:#340
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-5486
Mailing Address - Country:US
Mailing Address - Phone:817-769-3603
Mailing Address - Fax:817-348-0113
Practice Address - Street 1:4625 SAINT AMAND CIR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76126-1908
Practice Address - Country:US
Practice Address - Phone:817-769-3603
Practice Address - Fax:817-348-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1366773889Medicaid