Individual
DR. MARK R KEANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
415 6TH ST, LEWISTON, ID 83501-2431
(208) 750-7474
Mailing address
415 6TH STREET, LEWISTON, ID 83501-2424
(208) 750-7462
(208) 750-7467
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
24256
AZ
2084N0400X
Neurology Physician
Primary
M7728
ID
2084N0400X
Neurology Physician
MD00037909
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
128039
L & I WA
WA
05
—
7088867
—
WA
05
—
805433500
—
ID
05
—
8239543
—
WA
Enumeration date
09/22/2005
Last updated
12/26/2024
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