Provider Demographics
NPI:1801898218
Name:KISER, KEITH WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:WAYNE
Last Name:KISER
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 1:2205 WILLIAMS TRACE BLVD
Mailing Address - Street 2:#105
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4443
Mailing Address - Country:US
Mailing Address - Phone:281-980-2722
Mailing Address - Fax:
Practice Address - Street 1:2205 WILLIAMS TRACE BLVD
Practice Address - Street 2:#105
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4443
Practice Address - Country:US
Practice Address - Phone:281-980-2722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3524207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E77004Medicare UPIN
00B28BMedicare ID - Type Unspecified