Individual
STACEY LYN KEITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-1473
(254) 724-2111
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
278275
MA
2086S0127X
Trauma Surgery Physician
Primary
S7077
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/20/2013
Last updated
11/10/2020
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