Provider Demographics
NPI:1033180948
Name:NORD, KEITH DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:DOUGLAS
Last Name:NORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 STONEBRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3931
Mailing Address - Country:US
Mailing Address - Phone:731-427-7888
Mailing Address - Fax:731-265-4152
Practice Address - Street 1:111 STONEBRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3830
Practice Address - Country:US
Practice Address - Phone:731-427-7888
Practice Address - Fax:731-265-4159
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000026655207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3091423Medicaid
TN3091423Medicaid
TN1141740001Medicare NSC
TN3091423Medicare PIN
TN200025858Medicare PIN