Provider Demographics
NPI:1275747263
Name:BARRETT, KEITH ALAN (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:ALAN
Last Name:BARRETT
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 1:1900 LEIGHTON AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-3204
Mailing Address - Country:US
Mailing Address - Phone:256-235-8887
Mailing Address - Fax:256-770-4770
Practice Address - Street 1:1900 LEIGHTON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-3204
Practice Address - Country:US
Practice Address - Phone:256-235-8887
Practice Address - Fax:256-770-4770
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL33925208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR159669001Medicaid
H00173Medicare UPIN
AR5N323Medicare ID - Type Unspecified