Provider Demographics
NPI:1801839063
Name:KEITH, MARGARET LLANES (MD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:LLANES
Last Name:KEITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARGARET
Other - Middle Name:ANN
Other - Last Name:LLANES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 10549
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33733-0549
Mailing Address - Country:US
Mailing Address - Phone:727-944-3828
Mailing Address - Fax:727-939-4679
Practice Address - Street 1:247 S HUEY AVE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-4205
Practice Address - Country:US
Practice Address - Phone:727-944-3828
Practice Address - Fax:727-939-7230
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85572207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004545400Medicaid