Provider Demographics
NPI:1710062872
Name:KECK, PAUL E JR (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:KECK
Suffix:JR
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 1:231 ALBERT SABIN WAY
Mailing Address - Street 2:MAIL LOCATION 0559
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45267-0001
Mailing Address - Country:US
Mailing Address - Phone:513-558-6935
Mailing Address - Fax:513-558-4805
Practice Address - Street 1:231 ALBERT SABIN WAY
Practice Address - Street 2:MAIL LOCATION 0559
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-0001
Practice Address - Country:US
Practice Address - Phone:513-558-6935
Practice Address - Fax:513-558-4805
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350613822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH260029604OtherMEDICARE RAILROAD
OH0850271Medicaid
KY64937154Medicaid
OH0850271Medicaid
KY64937154Medicaid