Healthcare Provider Details

I. General information

NPI: 1336533991
Provider Name (Legal Business Name): KEEGAN HOVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2015
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC STREET RADIOLOGY DEPARTMENT
SEATTLE WA
98195-3358
US

IV. Provider business mailing address

3669 FRANCIS AVE N
SEATTLE WA
98103-8516
US

V. Phone/Fax

Practice location:
  • Phone: 415-676-8221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number281997
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD60881140
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: