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General NPI Number Information
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NPI Number | 1144252834
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Entity Type | Individual
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Provider Name | JULIUS KEITH SPEED DO
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Gender | Male
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 300 RAWLS DR STE 600
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City | MCCOMB
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State | MS
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Zip | 39648-2862
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Country | US
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Telephone | 601-249-4415
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Fax | 601-249-4474
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Provider Business Mailing Address
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Address Line | 209 MIDDLE ST
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City | TYLERTOWN
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State | MS
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Zip | 39667-2037
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Country | US
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Telephone | 601-341-4025
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 11133
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 11133
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License Number State | MS
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