Individual
MR. KEITH ALAN DISMUKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
202 HWY 80 EAST, DEMOPOLIS, AL 36732
(334) 289-0499
(334) 289-3013
Mailing address
PO BOX 650, DEMOPOLIS, AL 36732
(334) 289-0499
(334) 289-3013
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
00007346
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000088681
—
AL
01
—
0110247
UNITED HEALTHCARE
—
Enumeration date
07/28/2006
Last updated
03/14/2012
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