Provider Demographics
NPI:1235121609
Name:KEATS, CHRISTOPHER JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:KEATS
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 1:1300 114TH AVE SE
Mailing Address - Street 2:STE 210
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6942
Mailing Address - Country:US
Mailing Address - Phone:425-451-4761
Mailing Address - Fax:425-451-2361
Practice Address - Street 1:1300 114TH AVE SE
Practice Address - Street 2:STE 210
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6942
Practice Address - Country:US
Practice Address - Phone:425-451-4761
Practice Address - Fax:425-451-2361
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60343016102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD155871400Medicaid
186941Medicare ID - Type Unspecified
F42651Medicare UPIN