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General NPI Number Information
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NPI Number | 1174623383
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Entity Type | Organization
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Legal Business Name | GREGORY KEYES MD PS
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 06/03/2010
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Provider Practice Location Address
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Address Line | 123 BJUNE DR SE SUITE 101
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City | BAINBRIDGE ISLAND
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State | WA
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Zip | 98110-2503
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Country | US
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Telephone | 206-842-3222
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Fax | 206-842-1877
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Provider Business Mailing Address
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Address Line | 123 BJUNE DR SE SUITE 101
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City | BAINBRIDGE ISLAND
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State | WA
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Zip | 98110-2459
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Country | US
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Telephone | 206-842-3222
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Fax | 206-842-1877
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Authorized Official
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Title or Position | OWNER
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Name | GREGORY KEYES
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Credential | MD
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Telephone | 360-842-3222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD00019400
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License Number State | WA
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