Individual
DR. KEITH PEREIRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
645 E MISSOURI AVE STE 300, PHOENIX, AZ 85012-1351
(480) 207-4403
Mailing address
645 E MISSOURI AVE STE 300, PHOENIX, AZ 85012-1351
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
32618
AZ
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
32618
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
146320
STATE LICENSE
WI
01
—
28231
STATE LICENSE
WV
01
—
32618
STATE LICENSE
AZ
05
—
857477-01
—
AZ
01
—
AZ0736120
BC/BS
AZ
01
—
M12701
STATE LICENSE
ID
01
—
MD45253
STATE LICENSE
IA
Enumeration date
05/20/2006
Last updated
06/25/2024
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