MEDICARE: DR. KEITH DWIGHT HARBOUR 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	207Q00000X	Family Medicine Physician	G5147	TX

General Provider Information

NPI Number	:	1518985316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH DWIGHT HARBOUR D.O.

Provider Business Mailing Address
First Line	:	3233 DENTON HWY
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76117-3718
Country	:	US
Telephone Number	:	817-838-2381
Fax Number	:	817-838-2391

Provider Business Practice Location Address
First Line	:	3233 DENTON HWY
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76117-3718
Country	:	US
Telephone Number	:	817-838-2381
Fax Number	:	817-838-2391

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/09/2007

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