Basic Information
| Provider Information | |||||||||
| NPI: | 1104829480 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEEPES | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1510 | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477061510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123541052 | ||||||||
| FaxNumber: | 8123548280 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 W PIKE AVE | ||||||||
| Address2: | |||||||||
| City: | PETERSBURG | ||||||||
| State: | IN | ||||||||
| PostalCode: | 475678750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123541052 | ||||||||
| FaxNumber: | 8123548280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2005 | ||||||||
| LastUpdateDate: | 01/03/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01044355A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000042165 | 01 | IN | BCBS PIN | OTHER | 100373750 | 05 | IN | MEDICAID |