Basic Information
| Provider Information | |||||||||
| NPI: | 1093249351 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRISON | ||||||||
| FirstName: | KEELY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 80690 | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447080690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303637444 | ||||||||
| FaxNumber: | 3303637770 | ||||||||
| Practice Location | |||||||||
| Address1: | 603 MONROE ST | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446222046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303648889 | ||||||||
| FaxNumber: | 3303437505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2017 | ||||||||
| LastUpdateDate: | 10/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35.137616 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.