MEDICARE: WILLIAM R. KEITH JR. 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	207RG0100X	Gastroenterology Physician	ME0050381	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00102099	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	206855	OTHER	FL	AVMED
3	4198736	OTHER	FL	AETNA
4	08513	OTHER	FL	BCBS
5	2499169	OTHER	FL	GHI
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922001130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM R. KEITH JR. MD

Provider Business Mailing Address
First Line	:	2721 DEL PRADO BLVD S
Second Line	:	SUITE 200
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-5781
Country	:	US
Telephone Number	:	239-772-3636
Fax Number	:	239-772-5073

Provider Business Practice Location Address
First Line	:	2721 DEL PRADO BLVD S
Second Line	:	SUITE 200
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-5781
Country	:	US
Telephone Number	:	239-772-3636
Fax Number	:	239-772-5073

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	09/09/2010

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Directions to “ WILLIAM R. KEITH JR. MD” Practice Location

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