Provider Demographics
NPI:1942209382
Name:LEDFORD, KEITH (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:LEDFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 W 11TH PL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-4119
Mailing Address - Country:US
Mailing Address - Phone:432-264-7180
Mailing Address - Fax:
Practice Address - Street 1:1501 W 11TH PL
Practice Address - Street 2:SUITE 200
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-4119
Practice Address - Country:US
Practice Address - Phone:432-264-7180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5968207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F9502OtherBCBS OF TX
TX156955001Medicaid
TX8A4887Medicare PIN
TX156955001Medicaid