Healthcare Provider Details

I. General information

NPI: 1548261225
Provider Name (Legal Business Name): KEITH J URE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date: 03/22/2006
Reactivation Date: 03/30/2006

III. Provider practice location address

1004 CAROLINE ST
PORT ANGELES WA
98362-3902
US

IV. Provider business mailing address

1004 CAROLINE ST
PORT ANGELES WA
98362-3902
US

V. Phone/Fax

Practice location:
  • Phone: 360-457-1500
  • Fax: 360-157-1599
Mailing address:
  • Phone: 360-457-1500
  • Fax: 360-457-1599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC41937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: