MEDICARE: ROBERT C KEITH 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	174400000X	Specialist	OK13625	OK

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	:	1790783405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT C KEITH MD

Provider Business Mailing Address
First Line	:	1900 W 2ND ST
Second Line	:	STE B
City	:	ELK CITY
State	:	OK
Zip	:	73644-4327
Country	:	US
Telephone Number	:	580-225-1086
Fax Number	:	580-225-2429

Provider Business Practice Location Address
First Line	:	1900 W 2ND ST
Second Line	:	STE B
City	:	ELK CITY
State	:	OK
Zip	:	73644-4327
Country	:	US
Telephone Number	:	580-225-1086
Fax Number	:	580-225-2429

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	02/18/2014

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Directions to “ ROBERT C KEITH MD” Practice Location

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