Individual
KEENAN C. WANAMAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
3721
AZ
208600000X
Surgery Physician
DO-900
AL
2086S0129X
Vascular Surgery Physician
Primary
3721
AZ
Other
Enumeration date
06/16/2005
Last updated
05/10/2021
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