Provider Demographics
NPI:1407859598
Name:STARKWEATHER, KEITH DAVID (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:DAVID
Last Name:STARKWEATHER
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 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-296-9935
Practice Address - Street 1:980 PROFESSIONAL PARK DR.
Practice Address - Street 2:SUITE A
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5251
Practice Address - Country:US
Practice Address - Phone:931-905-1001
Practice Address - Fax:931-905-0410
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD28019207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3801399Medicaid
TN200026367OtherMEDICARE RAILROAD
G28841Medicare UPIN
TN3801399Medicaid