Provider Demographics
NPI:1376636886
Name:KEATING, GORDON W (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:W
Last Name:KEATING
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 1:1906 FEDERAL AVE EAST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-4239
Mailing Address - Country:US
Mailing Address - Phone:206-320-9100
Mailing Address - Fax:206-320-9099
Practice Address - Street 1:1906 FEDERAL AVE EAST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-4239
Practice Address - Country:US
Practice Address - Phone:206-320-9100
Practice Address - Fax:206-320-9099
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000118672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAK077OtherREGEANCE BLUE SHIELD
WAK077OtherREGEANCE BLUE SHIELD