Healthcare Provider Details

I. General information

NPI: 1477764405
Provider Name (Legal Business Name): WARREN LEE KEYS JR. LSA, CSA, OPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 10/07/2023
Certification Date: 10/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19202 LAKE RIDGE DR
MANVEL TX
77578-3858
US

IV. Provider business mailing address

PO BOX 84577
PEARLAND TX
77584-0012
US

V. Phone/Fax

Practice location:
  • Phone: 281-830-4845
  • Fax: 832-547-2249
Mailing address:
  • Phone: 281-830-4845
  • Fax: 713-436-1295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: