Healthcare Provider Details

I. General information

NPI: 1891789681
Provider Name (Legal Business Name): KATHRYN S. KEITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1167 A HWY 554
EL RITO NM
87530
US

IV. Provider business mailing address

PO BOX 805
EL RITO NM
87530-0805
US

V. Phone/Fax

Practice location:
  • Phone: 505-581-0033
  • Fax: 505-581-0034
Mailing address:
  • Phone: 505-581-0033
  • Fax: 505-581-0034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number74-187
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: