Provider Demographics
NPI:1356608475
Name:KEITHLEY, JOSHUA (MD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:KEITHLEY
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 1:1500 SOUTH MAIN STREET
Mailing Address - Street 2:JOHN PETER SMITH HOSPITAL ED,
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7339
Mailing Address - Country:US
Mailing Address - Phone:404-825-9222
Mailing Address - Fax:
Practice Address - Street 1:1500 SOUTH MAIN STREET
Practice Address - Street 2:JOHN PETER SMITH HOSPITAL ED,
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7339
Practice Address - Country:US
Practice Address - Phone:404-825-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-8876207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine