Individual
DR. KEITH PHILLIP DONALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5196 HILL RD E, SUITE 201, LAKEPORT, CA 95453-6360
(707) 263-4108
(707) 263-4101
Mailing address
5196 HILL RD E, SUITE 201, LAKEPORT, CA 95453-6360
(707) 263-4108
(707) 263-4101
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
G76641
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G766411
—
CA
Enumeration date
03/14/2007
Last updated
07/08/2007
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