MEDICARE: DR. KEITH LAMONT WINFREY MD

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	207R00000X	Internal Medicine Physician	024671	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649212382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH LAMONT WINFREY MD

Provider Business Mailing Address
First Line	:	4626 ALCEE FORTIER BLVD STE D
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70129-2130
Country	:	US
Telephone Number	:	504-255-8665
Fax Number	:	504-254-6447

Provider Business Practice Location Address
First Line	:	4626 ALCEE FORTIER BLVD STE D
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70129-2130
Country	:	US
Telephone Number	:	504-255-8665
Fax Number	:	504-254-6447

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

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	04/26/2011

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