Healthcare Provider Details

I. General information

NPI: 1083604573
Provider Name (Legal Business Name): DANIEL BRUCE KECK JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 VETERANS CENTER DRIVE
LEXINGTON KY
40502
US

IV. Provider business mailing address

LEXINGTON VA HEALTH CARE SYSTEM, 1101 VETERANS DRIVE
LEXINGTON KY
40502
US

V. Phone/Fax

Practice location:
  • Phone: 859-233-4511
  • Fax:
Mailing address:
  • Phone: 859-233-4511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number36005
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number36005
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: