Provider Demographics
NPI:1912154733
Name:SHEARLOCK, KEITH T (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:T
Last Name:SHEARLOCK
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 1:3001 LANGLEY AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-4715
Mailing Address - Country:US
Mailing Address - Phone:850-478-1400
Mailing Address - Fax:850-478-1440
Practice Address - Street 1:3001 LANGLEY AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-4715
Practice Address - Country:US
Practice Address - Phone:850-478-1400
Practice Address - Fax:850-478-1440
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 258942083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine