Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | ME128786 | FL |
NPI | 1023290475 |
---|---|
Provider Name | Dr. Douglas Scott Keith |
First Address | Jacksonville, FL 32216-3623 |
Second Address | Pensacola, FL 32504-8756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2007 |
Last Update Date | 21/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
017974800 | (05) | FL |
F45353 | (02) | |
ME128786 | FLORIDA MEDICAL LICENSURE (01) | FL |
P01853620 | FLORIDA RR MEDICARE (01) | FL |