Provider Demographics
NPI:1467523050
Name:CAPONE, KEITH JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:JOSEPH
Last Name:CAPONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KEITH
Other - Middle Name:J
Other - Last Name:CAPONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
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
Mailing Address - Country:US
Mailing Address - Phone:504-283-7306
Mailing Address - Fax:504-283-7308
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
Practice Address - Country:US
Practice Address - Phone:504-283-7306
Practice Address - Fax:504-283-7308
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015397208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1385999Medicaid