Provider Demographics
NPI:1144680133
Name:KEYES, LARRY
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
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 1:302 CHEYENNE RD
Mailing Address - Street 2:
Mailing Address - City:BURNS FLAT
Mailing Address - State:OK
Mailing Address - Zip Code:73624-0000
Mailing Address - Country:US
Mailing Address - Phone:405-264-6903
Mailing Address - Fax:
Practice Address - Street 1:100 S MONROE ST
Practice Address - Street 2:5
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-5722
Practice Address - Country:US
Practice Address - Phone:405-763-8063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator