Provider Demographics
NPI:1275588949
Name:KEYS, TONY D (MD)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:D
Last Name:KEYS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANTHONY
Other - Middle Name:D
Other - Last Name:KEYS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2262
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-0812
Mailing Address - Country:US
Mailing Address - Phone:909-426-4770
Mailing Address - Fax:909-426-4782
Practice Address - Street 1:222 N 2ND ST
Practice Address - Street 2:STE 315
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6109
Practice Address - Country:US
Practice Address - Phone:208-336-4825
Practice Address - Fax:208-336-2292
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM3871207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDA360058Medicare UPIN
IDA360058Medicare ID - Type Unspecified