Provider Demographics
NPI:1669793808
Name:KEITH, DAVID STEPHEN (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:STEPHEN
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 1:116 E 11TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-4300
Mailing Address - Country:US
Mailing Address - Phone:712-264-3595
Mailing Address - Fax:712-264-3599
Practice Address - Street 1:116 E 11TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4300
Practice Address - Country:US
Practice Address - Phone:712-264-3595
Practice Address - Fax:712-264-3599
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT013526207Q00000X
IA4434207Q00000X
PAOS016151207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1669793808Medicaid
IA1669793808Medicare PIN