Provider Demographics
NPI:1376949768
Name:KEITH J. CAPONE, MD, LLC
Entity Type:Organization
Organization Name:KEITH J. CAPONE, MD, LLC
Other - Org Name:LAKEVISTA PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOOKKEEPER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:DOTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-626-0855
Mailing Address - Street 1:6517 SPANISH FORT BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-4321
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6517 SPANISH FORT BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-4321
Practice Address - Country:US
Practice Address - Phone:504-283-7306
Practice Address - Fax:504-283-7308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-12
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1385999Medicaid