Provider Demographics
NPI:1063481455
Name:KEYES, JOHN L (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:KEYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:614 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-2539
Mailing Address - Country:US
Mailing Address - Phone:716-366-1047
Mailing Address - Fax:716-366-1182
Practice Address - Street 1:419 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2106
Practice Address - Country:US
Practice Address - Phone:716-366-1047
Practice Address - Fax:716-366-1182
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY129652208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000508007001OtherBLUE CROSS
NY00010089901OtherUNIVERA
NY000508007002OtherBLUE CROSS
P00147163OtherRAILROAD MEDICARE
NY000508007005OtherBLUE CROSS
NY000508007004OtherBLUE CROSS
NY00616528Medicaid
NY1703395OtherINDEPENDENT HEALTH
NY000508007002OtherBLUE CROSS
NY1703395OtherINDEPENDENT HEALTH