Provider Demographics
NPI:1508964453
Name:KEEL, KEYS S (MD)
Entity Type:Individual
Prefix:DR
First Name:KEYS
Middle Name:S
Last Name:KEEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KEYS
Other - Middle Name:S
Other - Last Name:KEEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:31542 S COAST HWY
Mailing Address - Street 2:STE 3
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-6987
Mailing Address - Country:US
Mailing Address - Phone:949-499-3915
Mailing Address - Fax:949-499-2585
Practice Address - Street 1:31542 S COAST HWY
Practice Address - Street 2:STE 3
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6987
Practice Address - Country:US
Practice Address - Phone:949-499-3915
Practice Address - Fax:949-499-2585
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55705207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A93389Medicare UPIN
G55705Medicare ID - Type Unspecified