Provider Demographics
NPI:1407941453
Name:ANTHONY D KEYS MD PA
Entity Type:Organization
Organization Name:ANTHONY D KEYS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:D
Authorized Official - Last Name:KEYS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-336-4825
Mailing Address - Street 1:222 N 2ND ST
Mailing Address - Street 2:SUITE 315
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6109
Mailing Address - Country:US
Mailing Address - Phone:208-336-4825
Mailing Address - Fax:208-336-2292
Practice Address - Street 1:222 N 2ND ST
Practice Address - Street 2:SUITE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM3871207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDA360058Medicare UPIN
ID1112724Medicare ID - Type Unspecified