Provider Demographics
NPI:1053375550
Name:ROUTH, L KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:L
Middle Name:KEITH
Last Name:ROUTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7150 N PRESIDENT GEORGE BUSH HWY STE 206
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-2208
Mailing Address - Country:US
Mailing Address - Phone:972-276-8994
Mailing Address - Fax:844-292-1462
Practice Address - Street 1:7150 N PRESIDENT GEORGE BUSH HWY STE 206
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-2208
Practice Address - Country:US
Practice Address - Phone:972-276-8994
Practice Address - Fax:844-292-1462
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2741207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133781804Medicaid
TX133781804Medicaid
TX85G112Medicare PIN