Individual
MR. KEITH WILLIAM MCGILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
150 S PICO AVE, 14342 BORA DR LA MIRADA 90638, LONG BEACH, CA 90802
(562) 432-2821
(562) 437-1353
Mailing address
150 S PICO AVE, 14342 BORA DRIVE LA MIRADA, CA 90638, LONG BEACH, CA 90802-6247
(562) 432-2821
(562) 437-1353
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
PA11313
CA
363AM0700X
Medical Physician Assistant
PA 11313
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA11313
PHYSICIAN ASST. LICENSE #
CA
Enumeration date
09/27/2006
Last updated
05/07/2008
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