Provider Demographics
NPI:1497712350
Name:WIED, KEITH ARNOLD (DO)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ARNOLD
Last Name:WIED
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 N 14TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1101
Mailing Address - Country:US
Mailing Address - Phone:409-833-5858
Mailing Address - Fax:409-833-1155
Practice Address - Street 1:950 N 14TH ST STE 100
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1112
Practice Address - Country:US
Practice Address - Phone:409-833-5858
Practice Address - Fax:409-833-1155
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2411207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88G457OtherBCBS
TX128359005Medicaid
TXF37161Medicare UPIN