Keith    Dismukes    MD
Contract Details
Dr. Keith Dismukes
Facility name
Provider ID
P000009071
NPI
1295749059
Tax ID
454772508
Effective Date
2/1/2018
Last Updated
2/12/2018
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
202 US-80
Demopolis, AL 36732
United States
County
Marengo
Phone
3342890499 (Phone)
Billing Details
Address
202 US-80
Demopolis, AL 36732
Billing Phone
3342890499
Specialty Type
Family Practice
Map
Address