Healthcare Provider Details

I. General information

NPI: 1285804971
Provider Name (Legal Business Name): BRENT KEITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7211 PRESTON RD STE 3500
PLANO TX
75024-0259
US

IV. Provider business mailing address

PO BOX 35629
DALLAS TX
75235-0629
US

V. Phone/Fax

Practice location:
  • Phone: 469-344-7667
  • Fax: 469-713-8037
Mailing address:
  • Phone: 214-424-2200
  • Fax: 214-231-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberGETP.LSU.G02053.F-G
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: