Provider Demographics
NPI:1366788580
Name:KEYSER, JOHN JACOB (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JACOB
Last Name:KEYSER
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4094 SPRING IS
Mailing Address - Street 2:
Mailing Address - City:OKATIE
Mailing Address - State:SC
Mailing Address - Zip Code:29909-4053
Mailing Address - Country:US
Mailing Address - Phone:843-987-0616
Mailing Address - Fax:843-987-3773
Practice Address - Street 1:4094 SPRING IS
Practice Address - Street 2:
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-4053
Practice Address - Country:US
Practice Address - Phone:843-987-0616
Practice Address - Fax:843-987-3773
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-15
Last Update Date:2012-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI38172086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery