Individual
DR. BRENT WAYNE KEENPORTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2620 W FAIDLEY AVE, GRAND ISLAND, NE 68803-4205
(308) 398-5424
Mailing address
16405 WEIR ST, OMAHA, NE 68135-1218
(402) 699-1991
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
19924
NE
Other
Enumeration date
03/29/2007
Last updated
07/08/2007
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