Provider Demographics
NPI:1457332066
Name:KEITH, STEPHEN PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:PAUL
Last Name:KEITH
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:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39649-0490
Mailing Address - Country:US
Mailing Address - Phone:601-249-2701
Mailing Address - Fax:601-249-2195
Practice Address - Street 1:300 RAWLS DR
Practice Address - Street 2:SUITE 1200
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2877
Practice Address - Country:US
Practice Address - Phone:601-249-4710
Practice Address - Fax:601-249-4716
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21847207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04829713Medicaid
MS04829713Medicaid