Provider Demographics
NPI:1912012618
Name:KEITH, DEBRA C (DO)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:C
Last Name:KEITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18215 STATE ROUTE 45 N
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MO
Mailing Address - Zip Code:64098-9101
Mailing Address - Country:US
Mailing Address - Phone:816-640-2762
Mailing Address - Fax:816-640-5564
Practice Address - Street 1:18215 STATE ROUTE 45 N
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MO
Practice Address - Zip Code:64098-9101
Practice Address - Country:US
Practice Address - Phone:816-640-2762
Practice Address - Fax:816-640-5564
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR1J75207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE86857Medicare UPIN