Basic Information
| Provider Information | |||||||||
| NPI: | 1467589663 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEELE | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | J | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1417 N MOUNT AUBURN RD | ||||||||
| Address2: | |||||||||
| City: | CAPE GIRARDEAU | ||||||||
| State: | MO | ||||||||
| PostalCode: | 637012171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738032941 | ||||||||
| FaxNumber: | 5738030815 | ||||||||
| Practice Location | |||||||||
| Address1: | 1417 N MOUNT AUBURN RD | ||||||||
| Address2: | |||||||||
| City: | CAPE GIRARDEAU | ||||||||
| State: | MO | ||||||||
| PostalCode: | 637012171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733346053 | ||||||||
| FaxNumber: | 5733347855 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 05/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2002008827 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 205849003 | 05 | MO | MEDICAID | DA4814 | 01 | MO | RAILROAD MEDICARE | OTHER |