Provider Demographics
NPI:1417131913
Name:KEYS PHYSICIAN SERVICES PA
Entity type:Organization
Organization Name:KEYS PHYSICIAN SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SPERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:239-432-9366
Mailing Address - Street 1:PO BOX 2928
Mailing Address - Street 2:
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037
Mailing Address - Country:US
Mailing Address - Phone:239-432-9366
Mailing Address - Fax:
Practice Address - Street 1:91500 O/S HWY
Practice Address - Street 2:MARINERS HOSPITAL
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070
Practice Address - Country:US
Practice Address - Phone:305-434-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38277Medicare PIN