Provider Demographics
NPI:1326541848
Name:SEARS, KEITH
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:SEARS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 COLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-6011
Mailing Address - Country:US
Mailing Address - Phone:512-903-0678
Mailing Address - Fax:
Practice Address - Street 1:5520 COLINTON AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-6011
Practice Address - Country:US
Practice Address - Phone:512-903-0678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-11
Last Update Date:2018-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle