Individual
MARI ANN KEITHAHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
105 N KEENE ST STE 102, COLUMBIA, MO 65201-8131
(573) 777-8738
(573) 777-8739
Mailing address
105 N KEENE ST STE 102, COLUMBIA, MO 65201-8131
(573) 777-8738
(573) 777-8739
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
111416
MO
207WX0107X
Retina Specialist (Ophthalmology) Physician
111416
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101298
BLUE CROSS BLUE SHIELD
MO
05
—
208468504
—
MO
Enumeration date
11/30/2005
Last updated
06/29/2021
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