Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 20A16288 | CA |
N | 207Q00000X | Family Doctor | 20A16288 | CA |
NPI | 1083900708 |
---|---|
Provider Name | Dr. Jordan Ann Keys |
First Address | Vallejo, CA 94592-1187 |
Second Address | Fairfield, CA 94533 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2011 |
Last Update Date | 22/05/2018 |