Healthcare Provider Details

I. General information

NPI: 1336146042
Provider Name (Legal Business Name): JOHN E KEYSER III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4535 HARDING PIKE STE 304
NASHVILLE TN
37205-2120
US

IV. Provider business mailing address

53 CENTURY BLVD SUITE 120
NASHVILLE TN
37214-3693
US

V. Phone/Fax

Practice location:
  • Phone: 615-269-9007
  • Fax:
Mailing address:
  • Phone: 615-346-6213
  • Fax: 615-346-6225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberTN14538
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberTN14538
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: