Provider Demographics
NPI:1215909825
Name:SMITH, KEITH PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:PATRICK
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KEITH
Other - Middle Name:P
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:901 LEIGHTON AVE
Mailing Address - Street 2:SUITE 705
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5700
Mailing Address - Country:US
Mailing Address - Phone:256-231-1322
Mailing Address - Fax:256-231-1324
Practice Address - Street 1:901 LEIGHTON AVE
Practice Address - Street 2:SUITE 705
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5700
Practice Address - Country:US
Practice Address - Phone:256-231-1322
Practice Address - Fax:256-231-1324
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25784208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL107338Medicaid
AL048155OtherBLUE CROSS BLUE SHIELD
AL529203130OtherMEDICAID
ALC12823OtherRAILROAD MEDICARE
ALD570OtherMEDICARE
ALP00400617OtherRAILROAD MEDICARE
ALC48415Medicare UPIN
AL051539582OtherBLUE CROSS/BLUE SHIELD