Individual
DR. KEITH KEVIN HARMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1700 RING RD, ELIZABETHTOWN, KY 42701-9497
(270) 769-5551
Mailing address
1811 NORTH DIXIE AVENUE, SUITE 104, #113, ELIZABETHTOWN, KY 42701
(208) 406-4058
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
35.126319
OH
208600000X
Surgery Physician
Primary
48134
KY
208600000X
Surgery Physician
M-10274
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010168443
REGENCE BLUE SHIELD
ID
05
—
0136330
—
OH
01
—
1059288
DESERET MUTUAL BENEFIT ADMINISTRATORS
ID
01
—
26-2759132
RAIL ROAD MEDICARE
ID
01
—
77535
BLUE CROSS
ID
05
—
808084800
—
ID
Enumeration date
05/22/2007
Last updated
07/20/2017
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