Individual
MR. KEATON ROBERT WHITCOMB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1501 SAN PEDRO DR SE, ALBUQUERQUE, NM 87108-5153
(505) 265-1711
Mailing address
1501 SAN PEDRO DR SE, ALBUQUERQUE, NM 87108-5153
(505) 265-1711
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA2023-0238
NM
363AS0400X
Surgical Physician Assistant
—
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/19/2021
Last updated
11/24/2024
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