Provider Demographics
NPI:1508040155
Name:HAYES, KEITH PHILIP (LMT/CNMT)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:PHILIP
Last Name:HAYES
Suffix:
Gender:M
Credentials:LMT/CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 VERMONT ST. NE
Mailing Address - Street 2:ST. C #104
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110
Mailing Address - Country:US
Mailing Address - Phone:505-417-9491
Mailing Address - Fax:
Practice Address - Street 1:2509 VERMONT ST NE
Practice Address - Street 2:ST. C #104
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4688
Practice Address - Country:US
Practice Address - Phone:505-417-9491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5111174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist