Individual
DR. KEITH DAVID CLANCY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7900 W JEFFERSON BLVD STE 306, FORT WAYNE, IN 46804-4128
(260) 458-3610
(260) 458-3611
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 479-3514
(260) 479-3520
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01079569A
IN
208600000X
Surgery Physician
036.090092
IL
208600000X
Surgery Physician
35.123491
OH
208600000X
Surgery Physician
MD067578-L
PA
2086S0102X
Surgical Critical Care Physician
35.123491
OH
2086S0102X
Surgical Critical Care Physician
MD067578-L
PA
2086S0127X
Trauma Surgery Physician
Primary
01079569A
IN
2086S0127X
Trauma Surgery Physician
036.090092
IL
2086S0127X
Trauma Surgery Physician
35.123491
OH
2086S0127X
Trauma Surgery Physician
MD067578-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001757641
—
PA
01
—
01122002
CAPITAL BLUE CROSS-WMG
PA
01
—
0342984000
AMERIHEALTH 65 PA
PA
01
—
039983
JOHNS HOPKINS
PA
01
—
117558
UNISON-WMG
PA
01
—
1506063
GATEWAY-WMG
PA
01
—
20006031
AMERIHEALTH MERCY-WMG
PA
01
—
491516
MAMSI-WMG
PA
01
—
562564
HIGHMARK BLUE SHIELD
PA
01
—
56845
GEISINGER
PA
01
—
610201
CAREFIRST MD BCBS
MD
01
—
7731206
AETNA
PA
Enumeration date
03/23/2006
Last updated
09/23/2020
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