Individual
DR. ROBERT NICOLAS KEENAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1374 S MISSION RD STE 408, FALLBROOK, CA 92028-4006
(951) 698-4650
Mailing address
1374 S MISSION RD STE 408, FALLBROOK, CA 92028-4006
(951) 698-4650
(951) 698-4651
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
A79742
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A797420
—
CA
01
—
YYY49687Y
SOUTHERN BLUE SHIELD
CA
01
—
ZZZ27707Z
NORTHERN BLUE SHIELD
CA
Enumeration date
04/14/2006
Last updated
06/15/2023
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