Provider Demographics
NPI:1215910526
Name:KEYLOR, HUBERT K (MD)
Entity type:Individual
Prefix:DR
First Name:HUBERT
Middle Name:K
Last Name:KEYLOR
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 1:2020 E STATE ST STE G
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-2479
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:356 E LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-1443
Practice Address - Country:US
Practice Address - Phone:330-337-4905
Practice Address - Fax:330-424-1811
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35025074207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4670173Medicaid
OH4670173Medicaid
OH0759863Medicare PIN