Provider Demographics
NPI:1184789992
Name:SEELY, KEITH ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ALAN
Last Name:SEELY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:P.O. BOX 1280
Mailing Address - Street 2:
Mailing Address - City:PALO CEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:96073-1280
Mailing Address - Country:US
Mailing Address - Phone:530-356-5507
Mailing Address - Fax:530-547-4661
Practice Address - Street 1:351 HARTNELL AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1845
Practice Address - Country:US
Practice Address - Phone:530-226-7540
Practice Address - Fax:530-226-7613
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2020-04-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG83413207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G834131Medicaid
CA00G834131Medicaid
00G834130Medicare PIN