Individual
KEITH THOMAS BANGART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
13660 N 94TH DR, #F1, PEORIA, AZ 85381-4836
(623) 974-0522
(623) 933-5787
Mailing address
13660 N 94TH DR, #F1, PEORIA, AZ 85381-4836
(623) 974-0522
(623) 933-5787
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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