Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 008055-1 | NY |
NPI | 1124025473 |
---|---|
Provider Name | Mr. Timothy D Keyes |
First Address | Syracuse, NY 13203-1843 |
Second Address | Syracuse, NY 13203-1807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2005 |
Last Update Date | 30/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P67625 | (02) |