Provider Demographics
NPI:1578856449
Name:KEATON, DAVID ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ANDREW
Last Name:KEATON
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 1:801 S. STEVENS STREET
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2564
Mailing Address - Country:US
Mailing Address - Phone:509-747-4455
Mailing Address - Fax:509-363-7064
Practice Address - Street 1:801 S STEVENS ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2654
Practice Address - Country:US
Practice Address - Phone:509-747-4455
Practice Address - Fax:509-363-7064
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD604177432085R0202X
WI653362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2022237Medicaid
WAG8961023Medicare PIN
WAG8961023Medicare PIN