Healthcare Provider Details

I. General information

NPI: 1407956600
Provider Name (Legal Business Name): GREGORY E KEYES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 BJUNE DRIVE SE SUITE 101
BAINBRIDGE ISLAND WA
98110-2503
US

IV. Provider business mailing address

123 BJUNE DR SE SUITE 101
BAINBRIDGE ISLAND WA
98110-2459
US

V. Phone/Fax

Practice location:
  • Phone: 206-842-3222
  • Fax: 206-842-1877
Mailing address:
  • Phone: 206-842-3222
  • Fax: 206-842-1877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00019400
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: