Provider Demographics
NPI:1689902330
Name:DUKES, KEITH OTTIS I
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:OTTIS
Last Name:DUKES
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60241
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95860-0241
Mailing Address - Country:US
Mailing Address - Phone:916-333-3927
Mailing Address - Fax:916-333-3935
Practice Address - Street 1:7325 HERLONG WAY
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-3433
Practice Address - Country:US
Practice Address - Phone:916-968-1312
Practice Address - Fax:916-333-3935
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6Y20333343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)