MEDICARE: DR. MATTHEW RICHARD KEYSOR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	DR.0069527	CO

General Provider Information

NPI Number	:	1306827050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW RICHARD KEYSOR M.D.

Provider Business Mailing Address
First Line	:	4190 E WOODMEN RD STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-8075
Country	:	US
Telephone Number	:	719-632-4455
Fax Number	:	719-419-2128

Provider Business Practice Location Address
First Line	:	4190 E WOODMEN RD STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-8075
Country	:	US
Telephone Number	:	719-632-4455
Fax Number	:	719-418-2128

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	09/05/2025

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