Healthcare Provider Details

I. General information

NPI: 1710904248
Provider Name (Legal Business Name): KEITH WILLIAM VAN METER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1816 INDUSTRIAL BLVD CHARITY HOSPITAL NEW ORLEANS
NEW ORLEANS LA
70058
US

IV. Provider business mailing address

1816 INDUSTRIAL BLVD
HARVEY LA
70058
US

V. Phone/Fax

Practice location:
  • Phone: 504-366-7638
  • Fax: 504-366-1029
Mailing address:
  • Phone: 504-366-7638
  • Fax: 504-263-2099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberLA012961
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: