Provider Demographics
NPI:1518157916
Name:KEYES, ELIZABETH ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ROSE
Last Name:KEYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2828 DUKE OF GLOUCESTER ST STE 106
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2073
Mailing Address - Country:US
Mailing Address - Phone:972-298-3888
Mailing Address - Fax:972-296-0838
Practice Address - Street 1:3120 MATLOCK RD
Practice Address - Street 2:STE 201
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015
Practice Address - Country:US
Practice Address - Phone:817-467-0889
Practice Address - Fax:817-557-4676
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXN2141208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202899501Medicaid