Individual
JACK P KEITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
45 GOLDER ST, LEWISTON, ME 04240-6033
(207) 755-3715
(207) 755-3728
Mailing address
PO BOX 1823, LEWISTON, ME 04241-1823
(207) 755-3715
(207) 755-3728
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
013034
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002622
ANTHEM BC/BS
ME
01
—
050029135
RAILROAD MEDICARE
—
05
—
316040099
—
ME
Enumeration date
08/13/2006
Last updated
04/26/2010
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