Provider Demographics
NPI:1821023052
Name:STEIN, KEITH LANCE (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:LANCE
Last Name:STEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8272 RIDING CLUB RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7262
Mailing Address - Country:US
Mailing Address - Phone:904-645-7276
Mailing Address - Fax:904-646-0779
Practice Address - Street 1:8272 RIDING CLUB RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7262
Practice Address - Country:US
Practice Address - Phone:904-645-7276
Practice Address - Fax:904-646-0779
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 55195207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B74525Medicare UPIN