Healthcare Provider Details

I. General information

NPI: 1487617395
Provider Name (Legal Business Name): KEITH S. MEREDITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E THOMAS RD BLDG C RM 1354
PHOENIX AZ
85016-7710
US

IV. Provider business mailing address

1919 E THOMAS RD BLDG C RM 1354
PHOENIX AZ
85016-7710
US

V. Phone/Fax

Practice location:
  • Phone: 602-546-0676
  • Fax: 602-546-5012
Mailing address:
  • Phone: 602-546-0676
  • Fax: 602-546-5012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number29578
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: