Provider Demographics
NPI:1730308065
Name:KEITH, CARMEN (MD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:KEITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6000 NORTHERN PASS DR STE A100
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911-7206
Mailing Address - Country:US
Mailing Address - Phone:915-600-2905
Mailing Address - Fax:915-600-7590
Practice Address - Street 1:6000 NORTHERN PASS DR STE A100
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79911-7206
Practice Address - Country:US
Practice Address - Phone:915-600-2905
Practice Address - Fax:915-600-7590
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2011034021207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology