Healthcare Provider Details

I. General information

NPI: 1306827050
Provider Name (Legal Business Name): MATTHEW RICHARD KEYSOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4190 E WOODMEN RD STE 100
COLORADO SPRINGS CO
80920-8075
US

IV. Provider business mailing address

4190 E WOODMEN RD STE 100
COLORADO SPRINGS CO
80920-8075
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-4455
  • Fax: 719-418-2128
Mailing address:
  • Phone: 719-632-4455
  • Fax: 719-419-2128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0069527
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: