Provider Demographics
NPI:1154302909
Name:KECK, CARLETON A (MD)
Entity Type:Individual
Prefix:MR
First Name:CARLETON
Middle Name:A
Last Name:KECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 BROADWAY
Mailing Address - Street 2:STE 440
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5395
Mailing Address - Country:US
Mailing Address - Phone:206-292-6252
Mailing Address - Fax:206-292-7893
Practice Address - Street 1:600 BROADWAY
Practice Address - Street 2:STE 440
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5395
Practice Address - Country:US
Practice Address - Phone:206-292-6252
Practice Address - Fax:206-292-7893
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD20431207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1047075Medicaid
WA1047075Medicaid
167802Medicare ID - Type Unspecified