Provider Demographics
NPI:1538229927
Name:KEEVIL, JEAN A (MD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:A
Last Name:KEEVIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7337
Mailing Address - Country:US
Mailing Address - Phone:541-842-7626
Mailing Address - Fax:541-842-7640
Practice Address - Street 1:99 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1787
Practice Address - Country:US
Practice Address - Phone:541-482-9741
Practice Address - Fax:541-488-6141
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD09191207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR005403000OtherBCBS
OR075168Medicaid
ORP00144657OtherRAILROAD MEDICARE
ORA51254Medicare UPIN
OR075168Medicaid