Provider Demographics
NPI:1992706444
Name:ASHBY, KEITH M (MD)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:M
Last Name:ASHBY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:201 4TH ST
Mailing Address - Street 2:STE 2D
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-8421
Mailing Address - Country:US
Mailing Address - Phone:318-443-6911
Mailing Address - Fax:318-443-6756
Practice Address - Street 1:201 4TH ST
Practice Address - Street 2:STE 2D
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8421
Practice Address - Country:US
Practice Address - Phone:318-443-6911
Practice Address - Fax:318-443-6756
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA10443R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1996084Medicaid
5V736Medicare ID - Type Unspecified
E19010Medicare UPIN