Provider Demographics
NPI:1194717033
Name:RITCHIE, KEITH L (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:L
Last Name:RITCHIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 RIVER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-6328
Mailing Address - Country:US
Mailing Address - Phone:801-943-7834
Mailing Address - Fax:801-944-3038
Practice Address - Street 1:1508 RIVER OAKS DR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-6328
Practice Address - Country:US
Practice Address - Phone:801-943-7834
Practice Address - Fax:801-944-3038
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT149956-1205207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT03982Medicaid
UT03982Medicaid
UT000000690Medicare ID - Type Unspecified