Provider Demographics
NPI:1760572960
Name:KEYS, KENT CALHOUN (MD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:CALHOUN
Last Name:KEYS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KENT
Other - Middle Name:CALHOUN
Other - Last Name:KEYS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1029 CHRISTINE AVENUE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5709
Mailing Address - Country:US
Mailing Address - Phone:256-237-0371
Mailing Address - Fax:256-236-4181
Practice Address - Street 1:1029 CHRISTINE AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5709
Practice Address - Country:US
Practice Address - Phone:256-237-0371
Practice Address - Fax:256-236-4181
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2013-01-29
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-07-26
Provider Licenses
StateLicense IDTaxonomies
AL00010962207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000015863Medicaid
AL000015863Medicare PIN
C75197Medicare UPIN
AL000015863Medicaid