Provider Demographics
NPI:1922196641
Name:KEYES, TED WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:WILLIAM
Last Name:KEYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 E 29TH AVE
Mailing Address - Street 2:SUITE 10-B #284
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-4855
Mailing Address - Country:US
Mailing Address - Phone:509-844-1150
Mailing Address - Fax:
Practice Address - Street 1:2525 E 29TH AVE
Practice Address - Street 2:SUITE 10-B #284
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4855
Practice Address - Country:US
Practice Address - Phone:509-844-1150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037151207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C99753Medicare UPIN