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General NPI Number Information
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NPI Number | 1730398165
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Entity Type | Individual
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Provider Name | KEITH KEVIN HARMON M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 07/20/2017
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Provider Practice Location Address
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Address Line | 1700 RING RD
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-9497
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Country | US
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Telephone | 270-769-5551
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Fax |
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Provider Business Mailing Address
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Address Line | 1811 NORTH DIXIE AVENUE, SUITE 104, #113
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701
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Country | US
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Telephone | 208-406-4058
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | M-10274
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 35.126319
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 48134
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License Number State | KY
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