1629061619 NPI number — DR. RICHARD D KEY M.D.

Table of content: DR. RICHARD D KEY M.D. (NPI 1629061619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629061619 NPI number — DR. RICHARD D KEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEY
Provider First Name:
RICHARD
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629061619
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1410
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOTHAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36302-1410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-793-0010
Provider Business Mailing Address Fax Number:
334-677-6791

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4370 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36305-1056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-793-0010
Provider Business Practice Location Address Fax Number:
334-677-6791
Provider Enumeration Date:
08/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  12737 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 481277597 . This is a "COMMERCIAL INSURANCE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51513834 . This is a "BLUE CROSS BLUE SHIELD AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051513834 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: J281 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: G079 . This is a "BCBS OF AL GROUP NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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