Healthcare Provider Details

I. General information

NPI: 1275588949
Provider Name (Legal Business Name): TONY D KEYS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: ANTHONY D KEYS MD

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 N 2ND ST STE 315
BOISE ID
83702-6109
US

IV. Provider business mailing address

PO BOX 2262
COLTON CA
92324-0812
US

V. Phone/Fax

Practice location:
  • Phone: 208-336-4825
  • Fax: 208-336-2292
Mailing address:
  • Phone: 909-426-4770
  • Fax: 909-426-4782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberM3871
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: