Provider Demographics
NPI:1700941325
Name:HALLMAN, KEITH O (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:O
Last Name:HALLMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2171
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310
Mailing Address - Country:US
Mailing Address - Phone:360-479-4905
Mailing Address - Fax:360-479-7018
Practice Address - Street 1:2520 CHERRY AVE
Practice Address - Street 2:PATHOLOGY DEPT HARRISON MEDICAL CENTER
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-4229
Practice Address - Country:US
Practice Address - Phone:360-792-6736
Practice Address - Fax:360-792-6561
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00012267207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAHA8173OtherREGENCE
WA91109177604OtherKPS
WA154366OtherLABOR & INDUSTRIES
WA8144008Medicaid
WAA07057Medicare UPIN
WA8144008Medicaid