Individual
DR. DENNIS J KEITHLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
621 S NEW BALLAS RD, CREVE COEUR, MO 63141-8232
(314) 251-6816
Mailing address
621 S NEW BALLAS RD, CREVE COEUR, MO 63141-8232
(314) 251-6816
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
34589
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518069087
—
MO
01
—
P00650207
RAILROAD MEDICARE
MO
Enumeration date
09/03/2006
Last updated
03/31/2015
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