Provider Demographics
NPI:1104178672
Name:DOW, WILLIAM KEITH (IDC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:KEITH
Last Name:DOW
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 REGULUS AVENUE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23461
Mailing Address - Country:US
Mailing Address - Phone:757-862-9999
Mailing Address - Fax:
Practice Address - Street 1:1636 REGULUS AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23461-2200
Practice Address - Country:US
Practice Address - Phone:757-862-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman