Basic Information
| Provider Information | |||||||||
| NPI: | 1942695069 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEITH | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | BETH CHEEVER | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11524 SPACE CENTER BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770593648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814870555 | ||||||||
| FaxNumber: | 9729573005 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 W ADOUE ST | ||||||||
| Address2: | |||||||||
| City: | ALVIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775112718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2818241480 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2015 | ||||||||
| LastUpdateDate: | 10/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | R5877 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.