Provider Demographics
NPI:1770651226
Name:KEYES, KENNETH S
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:S
Last Name:KEYES
Suffix:
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 1:3090 BRIDGER HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-7653
Mailing Address - Country:US
Mailing Address - Phone:406-586-8063
Mailing Address - Fax:
Practice Address - Street 1:3090 BRIDGER HILLS DR
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-7653
Practice Address - Country:US
Practice Address - Phone:406-586-8063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9828174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist