Healthcare Provider Details

I. General information

NPI: 1629023767
Provider Name (Legal Business Name): JAMES KEITH KEELING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 COTTAGE RD
CARTHAGE TX
75633-1466
US

IV. Provider business mailing address

PO BOX 549
CARTHAGE TX
75633-0549
US

V. Phone/Fax

Practice location:
  • Phone: 903-694-6626
  • Fax:
Mailing address:
  • Phone: 903-693-6626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberE8614
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: