Provider Demographics
NPI:1104847250
Name:PAUL R. KEITH MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:PAUL R. KEITH MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-977-1898
Mailing Address - Street 1:11254 FLORINDO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1302
Mailing Address - Country:US
Mailing Address - Phone:619-977-1898
Mailing Address - Fax:858-674-7493
Practice Address - Street 1:11254 FLORINDO RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1302
Practice Address - Country:US
Practice Address - Phone:619-977-1898
Practice Address - Fax:858-674-7493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA 87609Medicare UPIN