Gary  J  Keogh    MD
Contract Details
Gary Keogh, M.D., LLC
Facility name
Provider ID
P000000890
NPI
1790779577
Tax ID
208785589
Effective Date
4/15/2008
Last Updated
4/1/2016
Direct Contract
Yes
Term Date
4/1/2016
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
105 Villa Drive Suite A
Daphne, AL 36526
United States
County
Baldwin
Phone
2516214420 (Phone)
Billing Details
Address
105 Villa Drive
Suite A
Daphne, AL 36526
Billing Phone
2516214420
Specialty Type
Pain Medicine
Map
Address