Provider Demographics
NPI:1407817737
Name:KEISLER, LYDIA W (MD)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:W
Last Name:KEISLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 HAZEL ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-2850
Mailing Address - Country:US
Mailing Address - Phone:417-358-0188
Mailing Address - Fax:417-358-4612
Practice Address - Street 1:1515 HAZEL ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-2850
Practice Address - Country:US
Practice Address - Phone:417-358-0188
Practice Address - Fax:417-358-4612
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO101562207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207V00000XOtherTAXONOMY
MO209731827Medicaid
MO207V00000XOtherTAXONOMY
MO209731827Medicaid