Provider Demographics
NPI:1578543351
Name:KEYLOCK, JOREN BRENT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOREN
Middle Name:BRENT
Last Name:KEYLOCK
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:PO BOX 34245
Mailing Address - Street 2:PUGET SOUND INSTITUTE OF PATHOLOGY
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124
Mailing Address - Country:US
Mailing Address - Phone:206-622-7747
Mailing Address - Fax:253-426-6115
Practice Address - Street 1:1001 SW KLICKITAT WAY, SUITE 205
Practice Address - Street 2:PUGET SOUND INSTITUTE OF PATHOLOGY
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134
Practice Address - Country:US
Practice Address - Phone:206-622-7747
Practice Address - Fax:253-426-6115
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60212951207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology