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General NPI Number Information
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NPI Number | 1891850418
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Entity Type | Organization
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Legal Business Name | PAKC DSL INC PS
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 04/27/2010
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Provider Practice Location Address
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Address Line | 2520 CHERRY AVE PATHOLOGY DEPT HARRISON MEDICAL CENTER
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City | BREMERTON
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State | WA
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Zip | 98310
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Country | US
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Telephone | 360-744-6731
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Fax | 360-744-6561
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Provider Business Mailing Address
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Address Line | PO BOX 2171
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City | BREMERTON
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State | WA
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Zip | 98310-0368
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Country | US
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Telephone | 360-271-7274
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Fax | 360-479-7018
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEITH O HALLMAN
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Credential | MD
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Telephone | 360-792-6736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number |
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License Number State |
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