Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | MD20431 | WA |
NPI | 1154302909 |
---|---|
Provider Name | Mr. Carleton A Keck |
First Address | Seattle, WA 98122-5395 |
Second Address | Seattle, WA 98122-5395 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 11/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1047075 | (05) | WA |
A06463 | (02) |