Basic Information
| Provider Information | |||||||||
| NPI: | 1184608143 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEETCH | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9852 LEBANON GREENS DR | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631271514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148490046 | ||||||||
| FaxNumber: | 3145677961 | ||||||||
| Practice Location | |||||||||
| Address1: | 12855 N 40 DR | ||||||||
| Address2: | SUITE 375 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631418635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145676071 | ||||||||
| FaxNumber: | 3145677961 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2005 | ||||||||
| LastUpdateDate: | 05/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 036-104975 | IL | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | 100522 | MO | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.