Healthcare Provider Details

I. General information

NPI: 1407941453
Provider Name (Legal Business Name): ANTHONY D KEYS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 208-336-4825
  • Fax: 208-336-2292
Mailing address:
  • Phone: 208-336-4825
  • Fax: 208-336-2292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ANTHONY D KEYS
Title or Position: OWNER PRESIDENT
Credential: MD
Phone: 208-336-4825