Provider Demographics
NPI:1336152180
Name:PAIGE, KEITH T (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:T
Last Name:PAIGE
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 1:1100 OLIVE WAY MSC M4-PA
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1873
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-223-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036238208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0039572OtherLABOR & INDUSTRY
WAMD8236OtherALASKA MEDICAID
WAUS1037407OtherAETNA/USHC SPECIALIST
240007287OtherRAILROAD MEDICARE
WA8229619Medicaid
WAPA0297OtherBLUE SHIELD
WA8229619Medicaid
WAPA0297OtherBLUE SHIELD
WA8896004Medicare PIN