Provider Demographics
NPI:1578992855
Name:KEITER, JASON DAVID
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DAVID
Last Name:KEITER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 N KENDALL DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2118
Mailing Address - Country:US
Mailing Address - Phone:786-527-8219
Mailing Address - Fax:786-814-4240
Practice Address - Street 1:1150 NW 14TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-2137
Practice Address - Country:US
Practice Address - Phone:305-243-6591
Practice Address - Fax:305-243-6597
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107614363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant