Provider Demographics
NPI:1255347910
Name:WEISSINGER, KEITH ALLEN (MD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:ALLEN
Last Name:WEISSINGER
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 1:7424 BRIDGEPORT WAY W
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-8120
Mailing Address - Country:US
Mailing Address - Phone:253-581-2111
Mailing Address - Fax:253-581-2712
Practice Address - Street 1:7424 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE 103
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8120
Practice Address - Country:US
Practice Address - Phone:253-581-2111
Practice Address - Fax:253-581-2712
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00030882208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA187470OtherLABOR & INDUSTRY
WA8925990OtherCRIME VICTIMS
WA1082643Medicaid
WA187470OtherLABOR & INDUSTRY