Provider Demographics
NPI:1962447730
Name:SEETO, KEIFONG WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:KEIFONG
Middle Name:WILLIAM
Last Name:SEETO
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 1:960 LIBERTY ST SE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4165
Mailing Address - Country:US
Mailing Address - Phone:503-585-0575
Mailing Address - Fax:503-585-3301
Practice Address - Street 1:960 LIBERTY ST SE
Practice Address - Street 2:SUITE 140
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4165
Practice Address - Country:US
Practice Address - Phone:503-585-0575
Practice Address - Fax:503-585-3301
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD201672084N0400X, 2084N0600X
ORMD 201672084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR084749Medicaid
R102176Medicare PIN
OR084749Medicaid