MEDICARE: KEITH RAMSEY D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	036.151350	IL
2	208000000X	Pediatrics Physician	177150-1204	UT
3	208000000X	Pediatrics Physician	20A17355	CA
4	2080A0000X	Pediatric Adolescent Medicine Physician	177150-1204	UT

General Provider Information

NPI Number	:	1245294586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH RAMSEY D.O.

Provider Business Mailing Address
First Line	:	4105 W SHINNEROCK DR
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84009-6010
Country	:	US
Telephone Number	:	801-518-6973
Fax Number	:

Provider Business Practice Location Address
First Line	:	4105 W SHINNEROCK DR
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84009-6010
Country	:	US
Telephone Number	:	801-518-6973
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	02/07/2023

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