Provider Demographics
NPI:1407956600
Name:KEYES, GREGORY E (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:E
Last Name:KEYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 BJUNE DR SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2459
Mailing Address - Country:US
Mailing Address - Phone:206-842-3222
Mailing Address - Fax:206-842-1877
Practice Address - Street 1:123 BJUNE DRIVE SE
Practice Address - Street 2:SUITE 101
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2503
Practice Address - Country:US
Practice Address - Phone:206-842-3222
Practice Address - Fax:206-842-1877
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00019400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0171166OtherLABOR AND INDUSTRIES
WA4813KEOtherREGENCE BLUE SHIELD
WA1118314Medicaid
WA1118314Medicaid
G8800986Medicare PIN