Provider Demographics
NPI:1508862145
Name:KEITH, RONNIE (DO)
Entity Type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:
Last Name:KEITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 1330
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-1330
Mailing Address - Country:US
Mailing Address - Phone:405-307-6668
Mailing Address - Fax:405-701-6170
Practice Address - Street 1:2405 PALMER CIR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6349
Practice Address - Country:US
Practice Address - Phone:405-360-7100
Practice Address - Fax:405-364-9112
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1923208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100099950AMedicaid
OK248600601Medicare PIN
OK100099950AMedicaid