Provider Demographics
NPI:1053361691
Name:KEITH, KIMBERLY R (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:KEITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 AIRPORT BLVD STE A101
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6767
Mailing Address - Country:US
Mailing Address - Phone:251-633-8880
Mailing Address - Fax:251-378-6222
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:SUITE A101
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6705
Practice Address - Country:US
Practice Address - Phone:251-633-8880
Practice Address - Fax:251-634-4502
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL33360207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51516631OtherBCBS
LA1163503Medicaid
MS07627079Medicaid
AL891005430Medicaid
P71581Medicare UPIN
FL306126400Medicaid
AL051553890Medicare ID - Type Unspecified