Provider Demographics
NPI:1942447586
Name:ETEN, KEITH FRANCIS (IDC)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:FRANCIS
Last Name:ETEN
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:34800 BOB WILSON DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-1098
Mailing Address - Country:US
Mailing Address - Phone:619-524-5396
Mailing Address - Fax:619-524-9207
Practice Address - Street 1:34800 BOB WILSON DRIVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-1098
Practice Address - Country:US
Practice Address - Phone:619-524-5693
Practice Address - Fax:619-524-9207
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman