Healthcare Provider Details

I. General information

NPI: 1659035525
Provider Name (Legal Business Name): CRAIG KEYES IDMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 MDG / AVIANO AB / UNIT 6180
APO AE
09604-6180
US

IV. Provider business mailing address

31 MDG / AVIANO AB / UNIT 6180
APO AE
09604-6180
US

V. Phone/Fax

Practice location:
  • Phone: 314-226-9810
  • Fax:
Mailing address:
  • Phone: 314-226-9810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: