Individual
MELINDA G KEENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
263 SW PROFESSIONAL GLN, LAKE CITY, FL 32025-1105
(386) 755-6676
(386) 755-1667
Mailing address
263 SW PROFESSIONAL GLN, LAKE CITY, FL 32025-1105
(386) 755-6676
(386) 755-1667
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
ME105501
FL
208600000X
Surgery Physician
41693
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
FL
05
—
PENDING
—
TN
Enumeration date
04/10/2007
Last updated
11/18/2013
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