Provider Demographics
NPI:1407275092
Name:KEECH, JEFFREY JOHN
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:JOHN
Last Name:KEECH
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 1:1333 ST JOSEPH ST
Mailing Address - Street 2:UNIT 12
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204
Mailing Address - Country:US
Mailing Address - Phone:817-832-9908
Mailing Address - Fax:
Practice Address - Street 1:1333 SAINT JOSEPH ST
Practice Address - Street 2:UNIT 12
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6507
Practice Address - Country:US
Practice Address - Phone:817-832-9908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion