Provider Demographics
NPI:1265485411
Name:KEECH, PAMILA R (MD)
Entity Type:Individual
Prefix:
First Name:PAMILA
Middle Name:R
Last Name:KEECH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13030 121ST WAY NE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3008
Mailing Address - Country:US
Mailing Address - Phone:425-899-5111
Mailing Address - Fax:425-899-5114
Practice Address - Street 1:13030 121ST WAY NE
Practice Address - Street 2:SUITE 102
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3008
Practice Address - Country:US
Practice Address - Phone:425-899-5111
Practice Address - Fax:425-899-5114
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026533174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA390007234OtherRAILROAD MEDICARE PIN
WA1080217Medicaid
WA390007234OtherRAILROAD MEDICARE PIN
WAGAB11027Medicare PIN