Provider Demographics
NPI:1750561379
Name:ARNOLD, KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5830 ROBIN HILL DR
Mailing Address - Street 2:SPACE 8
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-6023
Mailing Address - Country:US
Mailing Address - Phone:707-263-3670
Mailing Address - Fax:707-263-3670
Practice Address - Street 1:5830 ROBIN HILL DR
Practice Address - Street 2:SPACE 8
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-6023
Practice Address - Country:US
Practice Address - Phone:707-263-3670
Practice Address - Fax:707-263-3670
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAFE29635207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20OtherALLOPATHIC PHYSICIAN