Provider Demographics
NPI:1063444198
Name:KEITH, DOUGLAS CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:CHARLES
Last Name:KEITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:220 US HIGHWAY 70 W
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-3943
Mailing Address - Country:US
Mailing Address - Phone:919-779-7890
Mailing Address - Fax:919-779-7896
Practice Address - Street 1:220 US HIGHWAY 70 W
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-3943
Practice Address - Country:US
Practice Address - Phone:919-779-7890
Practice Address - Fax:919-779-7896
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30184208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE81249Medicare UPIN