Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 036.151350 | IL |
N | 208000000X | Pediatrician | 177150-1204 | UT |
N | 208000000X | Pediatrician | 20A17355 | CA |
Y | 2080A0000X | Adolescent Medicine | 177150-1204 | UT |
NPI | 1245294586 |
---|---|
Provider Name | Keith Ramsey |
First Address | Galesburg, IL 61401-1160 |
Second Address | Galesburg, IL 61401-1251 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 17/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F64759 | (02) | UT |