Provider Demographics
NPI:1811911449
Name:JUNIOR, KEITH E (MD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:E
Last Name:JUNIOR
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 1:617 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-3819
Mailing Address - Country:US
Mailing Address - Phone:615-226-1695
Mailing Address - Fax:615-226-2679
Practice Address - Street 1:617 S 8TH ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-3819
Practice Address - Country:US
Practice Address - Phone:615-228-8902
Practice Address - Fax:615-226-2679
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21938207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4038115Medicaid
TNF46971Medicare UPIN
TN4038115Medicaid