Provider Demographics
NPI:1427011444
Name:MEYER, KEITH DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:DOUGLAS
Last Name:MEYER
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 1:1411 N FLAGLER DR
Mailing Address - Street 2:SUITE 9500
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3404
Mailing Address - Country:US
Mailing Address - Phone:561-820-0122
Mailing Address - Fax:561-820-8840
Practice Address - Street 1:1411 N FLAGLER DR
Practice Address - Street 2:SUITE 9500
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3404
Practice Address - Country:US
Practice Address - Phone:561-820-0122
Practice Address - Fax:561-820-8840
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064245207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25230VOtherPTAN
25230Medicare ID - Type Unspecified
FL25230VOtherPTAN