MEDICARE: KEITH W LOUDEN M D PA

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	207X00000X	Orthopaedic Surgery Physician	K2062	TX

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	:	1982602611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEITH W LOUDEN M D PA

Provider Business Mailing Address
First Line	:	5632 EDWARDS RANCH RD.
Second Line	:	SUITE 100
City	:	FORT WORTH
State	:	TX
Zip	:	76109
Country	:	US
Telephone Number	:	817-336-7188
Fax Number	:	844-231-8865

Provider Business Practice Location Address
First Line	:	5632 EDWARDS RANCH RD.
Second Line	:	SUITE 100
City	:	FORT WORTH
State	:	TX
Zip	:	76109
Country	:	US
Telephone Number	:	817-336-7188
Fax Number	:	844-231-8865

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	KEITH WARD LOUDEN
Credential	:	MD
Telephone Number	:	817-336-7188

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	01/08/2020

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