Healthcare Provider Details

I. General information

NPI: 1457332066
Provider Name (Legal Business Name): STEPHEN PAUL KEITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 RAWLS DR SUITE 1200
MCCOMB MS
39648-2877
US

IV. Provider business mailing address

PO BOX 490
MCCOMB MS
39649-0490
US

V. Phone/Fax

Practice location:
  • Phone: 601-249-4710
  • Fax: 601-249-4716
Mailing address:
  • Phone: 601-249-2701
  • Fax: 601-249-2195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2023050205
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberDR.0045885
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number21847
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD2024-1017
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: