Provider Demographics
NPI:1346803715
Name:MCKEEVER, GREGORY D
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:D
Last Name:MCKEEVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21527 4TH AVE W APT C44
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-7579
Mailing Address - Country:US
Mailing Address - Phone:425-753-1210
Mailing Address - Fax:
Practice Address - Street 1:23008 56TH AVE W
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-4754
Practice Address - Country:US
Practice Address - Phone:425-678-6008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-20
Last Update Date:2019-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60523073208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation