Provider Demographics
NPI:1912175977
Name:KEEP, LISA W (MD, MPH, FACPM)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:W
Last Name:KEEP
Suffix:
Gender:F
Credentials:MD, MPH, FACPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11421 89TH RD
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32060-7175
Mailing Address - Country:US
Mailing Address - Phone:386-362-6851
Mailing Address - Fax:386-362-6851
Practice Address - Street 1:11421 89TH RD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32060-7175
Practice Address - Country:US
Practice Address - Phone:386-362-6851
Practice Address - Fax:386-362-6851
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME977032083P0901X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice