Provider Demographics
NPI:1063719474
Name:DAVID B. KEDDY, M.D.
Entity type:Organization
Organization Name:DAVID B. KEDDY, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:KEDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-961-1611
Mailing Address - Street 1:12831 6TH ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:LILLIAN
Mailing Address - State:AL
Mailing Address - Zip Code:36549-4166
Mailing Address - Country:US
Mailing Address - Phone:251-961-1611
Mailing Address - Fax:251-961-1613
Practice Address - Street 1:12831 6TH ST
Practice Address - Street 2:SUITE H
Practice Address - City:LILLIAN
Practice Address - State:AL
Practice Address - Zip Code:36549-4166
Practice Address - Country:US
Practice Address - Phone:251-961-1611
Practice Address - Fax:251-961-1613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15496207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty