Provider Demographics
NPI:1649212382
Name:WINFREY, KEITH LAMONT (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:LAMONT
Last Name:WINFREY
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 1:4626 ALCEE FORTIER BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70129-2130
Mailing Address - Country:US
Mailing Address - Phone:504-255-8665
Mailing Address - Fax:504-254-6447
Practice Address - Street 1:4626 ALCEE FORTIER BLVD STE D
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70129-2130
Practice Address - Country:US
Practice Address - Phone:504-255-8665
Practice Address - Fax:504-254-6447
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024671207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1574325Medicaid
LAH48115Medicare UPIN
LA4A647Medicare ID - Type Unspecified