Individual
JERRY KEATON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
700 E MARSHALL AVE, LONGVIEW, TX 75601-5580
(903) 315-2072
(903) 247-0222
Mailing address
SS9 LAKE CHEROKEE, HENDERSON, TX 75652-8615
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
04-19229
KS
2085R0202X
Diagnostic Radiology Physician
14699
OK
2085R0202X
Diagnostic Radiology Physician
Primary
J2634
TX
2085R0202X
Diagnostic Radiology Physician
ME172978
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012079
TX KINDNEY HEALTH
TX
01
—
116857701
COUNTY AGENCY
TX
01
—
116857702
CIDC
TX
01
—
117915
CHIP PROGRAM
TX
05
—
88R991
—
TX
01
—
88R995
BLUE CROSS BLUE SHIELD TX
TX
01
—
MDJ2634
WORKERS COMP
TX
01
—
P00048099
TRAVELER MEDICARE
TX
Enumeration date
04/25/2006
Last updated
04/29/2025
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