Healthcare Provider Details

I. General information

NPI: 1588313084
Provider Name (Legal Business Name): SPENCER PAUL KECK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 VERMONT AVE
OAK RIDGE TN
37830-6471
US

IV. Provider business mailing address

100 VERMONT AVE
OAK RIDGE TN
37830-6471
US

V. Phone/Fax

Practice location:
  • Phone: 865-482-1777
  • Fax: 865-374-2117
Mailing address:
  • Phone: 865-482-1777
  • Fax: 865-374-2117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6503
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: