Individual
MR. KEITH ALAN DEARDORFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4763 POLEPLANT DR, COLORADO SPRINGS, CO 80918-5255
(850) 305-4495
Mailing address
4763 POLEPLANT DR, COLORADO SPRINGS, CO 80918-5255
(850) 305-4495
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
APN.0996683-NP
CO
363LF0000X
Family Nurse Practitioner
Primary
COA.14807.NP
OH
Other
Enumeration date
11/29/2012
Last updated
12/06/2021
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