Provider Demographics
NPI:1174649123
Name:KEYSER, PETER DIRCK (DO)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:DIRCK
Last Name:KEYSER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 TOWN SIDE DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-6803
Mailing Address - Country:US
Mailing Address - Phone:919-387-0263
Mailing Address - Fax:
Practice Address - Street 1:831 W MORGAN ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27699-4278
Practice Address - Country:US
Practice Address - Phone:910-844-3078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700081207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCD97459Medicare UPIN