Provider Demographics
NPI:1558469734
Name:STRAIN, KEITH ELIOT (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:ELIOT
Last Name:STRAIN
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:ONE SAINT MARY PLACE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4343
Mailing Address - Country:US
Mailing Address - Phone:318-681-6174
Mailing Address - Fax:318-681-6162
Practice Address - Street 1:ONE SAINT MARY PLACE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4343
Practice Address - Country:US
Practice Address - Phone:318-381-6174
Practice Address - Fax:318-681-6162
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16379208000000X, 2080P0204X
LAMD.163792080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1389838Medicaid
LA5N257Medicare PIN
LAE57306Medicare UPIN
LA1389838Medicaid