Individual
DR. JOHN KEITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-2538
(601) 815-1854
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-2538
(601) 815-1854
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036-116795
IL
207P00000X
Emergency Medicine Physician
17041
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00124339
—
MS
05
—
0361166795
—
IL
01
—
512G700003
MS MEDICARE - GROUP
MS
Enumeration date
07/08/2006
Last updated
04/07/2008
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