Individual
MARI ANN KEITHAHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
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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