Individual
DR. KEITH R MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1567 S RANGE AVE, DENHAM SPRINGS, LA 70726-5201
(225) 665-3500
(225) 665-3518
Mailing address
1567 S RANGE AVE, DENHAM SPRINGS, LA 70726-5201
(225) 665-3500
(225) 665-3518
Taxonomy
Speciality
Code
Description
License number
State
202C00000X
Independent Medical Examiner Physician
Primary
14885
LA
Other
Enumeration date
06/14/2007
Last updated
07/08/2007
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