=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699902965
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HOLLY KEYT MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2009
-----------------------------------------------------
Last Update Date | 03/08/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4502 MEDICAL DR
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229-4402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-358-4000
-----------------------------------------------------
Fax | 210-949-3006
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4502 MEDICAL DR
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229-4402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-358-4000
-----------------------------------------------------
Fax | 210-949-3006
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | P7293
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | P7293
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------