MEDICARE: DR. JEFFREY P KECK JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	049765	GA
2	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	049765	GA
3	207L00000X	Anesthesiology Physician	43374	KY
4	207L00000X	Anesthesiology Physician	2012004815	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467422113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY P KECK JR. M.D.

Provider Business Mailing Address
First Line	:	1701 LACEY ST
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-5230
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 LACEY ST
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-5230
Country	:	US
Telephone Number	:	573-334-4822
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	04/05/2016

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Directions to “ DR. JEFFREY P KECK JR. M.D.” Practice Location

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