Provider Demographics
NPI:1982602611
Name:KEITH W LOUDEN M D PA
Entity Type:Organization
Organization Name:KEITH W LOUDEN M D PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:WARD
Authorized Official - Last Name:LOUDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-336-7188
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
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?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153023001Medicaid
H57813Medicare UPIN
TX00113UMedicare PIN