=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891768180
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEITH ALLAN STOWERS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5495 N BEND RD SUITE 101
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41005-9378
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-586-9030
-----------------------------------------------------
Fax | 859-334-4373
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 MEDICAL VILLAGE DR SUITE 102
-----------------------------------------------------
City | EDGEWOOD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41017-5401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-341-1011
-----------------------------------------------------
Fax | 859-341-7198
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 23025
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 35051059
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------