Basic Information
| Provider Information | |||||||||
| NPI: | 1154421717 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEITH | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 404 BARCELONA AVE | ||||||||
| Address2: | |||||||||
| City: | VENICE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342851754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9414834705 | ||||||||
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| Practice Location | |||||||||
| Address1: | 606 4TH AVE W | ||||||||
| Address2: | |||||||||
| City: | PALMETTO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342215226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417227785 | ||||||||
| FaxNumber: | 9417295267 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2006 | ||||||||
| LastUpdateDate: | 05/18/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | M2363 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ME111881 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.