Healthcare Provider Details

I. General information

NPI: 1073559829
Provider Name (Legal Business Name): JOHN ALVIN KEITH III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 MCCLURE COURT
FLORENCE SC
29505-6046
US

IV. Provider business mailing address

1530 MCCLURE COURT
FLORENCE SC
29505-0000
US

V. Phone/Fax

Practice location:
  • Phone: 843-667-6710
  • Fax: 843-317-9784
Mailing address:
  • Phone: 843-667-6710
  • Fax: 843-317-9784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21320
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: