Provider Demographics
NPI:1598886533
Name:KEYES, MARSHALL JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:JAY
Last Name:KEYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MARSHALL
Other - Middle Name:JAY
Other - Last Name:KEYES, MD A MEDICAL CORPORATION
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1964 WESTWOOD BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4651
Mailing Address - Country:US
Mailing Address - Phone:310-446-1822
Mailing Address - Fax:310-446-1362
Practice Address - Street 1:1964 WESTWOOD BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4651
Practice Address - Country:US
Practice Address - Phone:310-446-1822
Practice Address - Fax:310-446-1362
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG26695207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G266950Medicaid
CA00G266950Medicaid