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Individual
KEITH THOMAS BANGART
Active
Individual
KEITH THOMAS BANGART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
0724
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0724
LICENSE #
AZ
01
—
6647440001
NSC PTAN
AZ
Enumeration date
03/24/2011
Last updated
03/07/2023
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