Healthcare Provider Details

I. General information

NPI: 1922196641
Provider Name (Legal Business Name): TED WILLIAM KEYES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 E 29TH AVE SUITE 10-B #284
SPOKANE WA
99223-4855
US

IV. Provider business mailing address

2525 E 29TH AVE SUITE 10-B #284
SPOKANE WA
99223-4855
US

V. Phone/Fax

Practice location:
  • Phone: 509-844-1150
  • Fax:
Mailing address:
  • Phone: 509-844-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD00037151
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: