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General NPI Number Information
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NPI Number | 1972608297
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Entity Type | Individual
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Provider Name | KEITH M GAUTREAUX M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 825 SE BISHOP BLVD STE 401
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City | PULLMAN
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State | WA
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Zip | 99163-5517
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Country | US
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Telephone | 509-336-7720
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Fax | 509-715-2131
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Provider Business Mailing Address
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Address Line | 915 NE VALLEY RD
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City | PULLMAN
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State | WA
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Zip | 99163-3845
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Country | US
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Telephone | 509-332-3548
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Fax | 509-332-5253
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 24201
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD60322685
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License Number State | WA
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