Provider Demographics
NPI:1154421717
Name:KEITH, THOMAS A (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:KEITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:404 BARCELONA AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-1754
Mailing Address - Country:US
Mailing Address - Phone:941-483-4705
Mailing Address - Fax:
Practice Address - Street 1:606 4TH AVE W
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-5226
Practice Address - Country:US
Practice Address - Phone:941-722-7785
Practice Address - Fax:941-729-5267
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2363207Q00000X
FLME111881207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine