MEDICARE: DR. HUBERT K KEYLOR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35025074	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215910526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HUBERT K KEYLOR MD

Provider Business Mailing Address
First Line	:	2020 E STATE ST STE G
Second Line	:
City	:	SALEM
State	:	OH
Zip	:	44460-2479
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	356 E LINCOLN WAY
Second Line	:
City	:	LISBON
State	:	OH
Zip	:	44432-1443
Country	:	US
Telephone Number	:	330-337-4905
Fax Number	:	330-424-1811

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	07/05/2011

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