Individual
MR. JUSTIN KEADLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1010 MURRAY AVE, SAN LUIS OBISPO, CA 93405-1806
(805) 546-1997
Mailing address
1010 MURRAY AVE, SAN LUIS OBISPO, CA 93405-1806
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
C05327
MD
363AS0400X
Surgical Physician Assistant
Primary
PA53511
CA
Other
Enumeration date
02/07/2014
Last updated
09/22/2016
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