=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407941453
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANTHONY D KEYS MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 222 N 2ND ST SUITE 315
-----------------------------------------------------
City | BOISE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83702-6109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-336-4825
-----------------------------------------------------
Fax | 208-336-2292
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 222 N 2ND ST SUITE 315
-----------------------------------------------------
City | BOISE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83702-6109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-336-4825
-----------------------------------------------------
Fax | 208-336-2292
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PRESIDENT
-----------------------------------------------------
Name | DR. ANTHONY D KEYS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 208-336-4825
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | M3871
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------