Provider Demographics
NPI:1104267533
Name:KEIL, JOSHUA ISRAEL (DO)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:ISRAEL
Last Name:KEIL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 280148
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32228-0148
Mailing Address - Country:US
Mailing Address - Phone:904-270-4328
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 2104 MASSEY AVENUE
Practice Address - Street 2:
Practice Address - City:NAS MAYPORT
Practice Address - State:FL
Practice Address - Zip Code:32228
Practice Address - Country:US
Practice Address - Phone:904-270-4328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013020880152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist