Provider Demographics
NPI:1255373635
Name:KEISTER, ALAN WADE (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:WADE
Last Name:KEISTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1215 S COULTER ST
Mailing Address - Street 2:SUITE #301
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1758
Mailing Address - Country:US
Mailing Address - Phone:806-355-9741
Mailing Address - Fax:806-356-0045
Practice Address - Street 1:1215 S COULTER ST
Practice Address - Street 2:SUITE #301
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1758
Practice Address - Country:US
Practice Address - Phone:806-355-9741
Practice Address - Fax:806-356-0045
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-12-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK9315207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK9315OtherSTATE LICENSE
TX0055MBOtherBCBS
TX038789602Medicaid
TX116563101OtherFIRST CARE
TX116563101OtherFIRST CARE
TXK9315OtherSTATE LICENSE
TXH11253Medicare UPIN