Healthcare Provider Details

I. General information

NPI: 1780117549
Provider Name (Legal Business Name): KEITH CHARLES ARNOLD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2017
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 N 4TH ST
FLAGSTAFF AZ
86004-4227
US

IV. Provider business mailing address

2001 N 4TH ST
FLAGSTAFF AZ
86004-4227
US

V. Phone/Fax

Practice location:
  • Phone: 928-527-4325
  • Fax:
Mailing address:
  • Phone: 828-527-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2018-02102
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number62094
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: