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General NPI Number Information
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NPI Number | 1174793590
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Entity Type | Individual
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Provider Name | LANCE R KECK PA-C
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Gender | Male
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Dates
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Enumeration Date | 03/03/2008
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Last Update Date | 12/04/2020
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Provider Practice Location Address
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Address Line | 1708 YAKIMA AVE STE 102
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City | TACOMA
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State | WA
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Zip | 98405-5307
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Country | US
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Telephone | 253-272-7777
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Fax | 360-830-1385
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Provider Business Mailing Address
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Address Line | 1708 YAKIMA AVE STE 102
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City | TACOMA
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State | WA
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Zip | 98405-5307
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Country | US
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Telephone | 253-272-7777
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Fax | 360-830-1385
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA01360
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA60109612
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA60109612
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License Number State | WA
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