Healthcare Provider Details

I. General information

NPI: 1023290475
Provider Name (Legal Business Name): DOUGLAS SCOTT KEITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5149 N 9TH AVE
PENSACOLA FL
32504-8756
US

IV. Provider business mailing address

4205 BELFORT RD STE 4015
JACKSONVILLE FL
32216-3623
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-1080
  • Fax: 850-416-1089
Mailing address:
  • Phone: 904-450-6014
  • Fax: 904-450-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME128786
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: