Healthcare Provider Details

I. General information

NPI: 1114161692
Provider Name (Legal Business Name): KEITH SAXTON GATES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 15TH AVE SE
PUYALLUP WA
98372-3715
US

IV. Provider business mailing address

401 15TH AVE SE
PUYALLUP WA
98372-3715
US

V. Phone/Fax

Practice location:
  • Phone: 253-697-1848
  • Fax:
Mailing address:
  • Phone: 253-697-1848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberMD60414696
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberN2523
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD60414696
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberN2523
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: