Provider Demographics
NPI:1659327062
Name:LOFTIN, KEISHA L (MD)
Entity Type:Individual
Prefix:DR
First Name:KEISHA
Middle Name:L
Last Name:LOFTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8257 FREDERICKSBURG RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3357
Mailing Address - Country:US
Mailing Address - Phone:210-614-7993
Mailing Address - Fax:210-692-0432
Practice Address - Street 1:8257 FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3357
Practice Address - Country:US
Practice Address - Phone:210-614-7993
Practice Address - Fax:210-692-0432
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6503207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8X8740OtherBLUE CROSS BLUE SHIELD
TX158063103Medicaid
TXL6503OtherMD LICENSE
TX8F4166Medicare PIN