Provider Demographics
NPI:1275511198
Name:HANLEY, KEITH (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:HANLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 NIMITZ RD
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4969
Mailing Address - Country:US
Mailing Address - Phone:808-254-4047
Mailing Address - Fax:
Practice Address - Street 1:MARINE AIRCRAFT GROUP 24, 1MARINE AIRCRAFT WING
Practice Address - Street 2:PSD BOX 63047
Practice Address - City:MCBH KANEOHE BAY
Practice Address - State:HI
Practice Address - Zip Code:96863-3047
Practice Address - Country:US
Practice Address - Phone:808-257-1371
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD 100212083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine