Provider Demographics
NPI:1811995541
Name:LOUDEN, KEITH WARD (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:WARD
Last Name:LOUDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5632 EDWARDS RANCH RD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109
Mailing Address - Country:US
Mailing Address - Phone:817-336-7188
Mailing Address - Fax:844-231-8865
Practice Address - Street 1:5632 EDWARDS RANCH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109
Practice Address - Country:US
Practice Address - Phone:817-336-7188
Practice Address - Fax:844-231-8865
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2062207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153025501Medicaid
TX8445B9Medicare PIN
TX153025501Medicaid