=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588666267
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEITH SHUTE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2005
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 59 PAGE HILL RD
-----------------------------------------------------
City | BERLIN
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03570-3531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-752-2900
-----------------------------------------------------
Fax | 603-752-3727
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 133 PLEASANT ST
-----------------------------------------------------
City | BERLIN
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03570-2006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-752-2040
-----------------------------------------------------
Fax | 603-752-1709
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 9083
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------