MEDICARE: JOHN A. KEECH JR. D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	20A6222	CA
2	207RH0003X	Hematology & Oncology Physician	OP60102903	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	8300001778	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164426524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN A. KEECH JR. D.O.

Provider Business Mailing Address
First Line	:	4545 POINT FOSDICK DR NW
Second Line	:	SUITE 215
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1700
Country	:	US
Telephone Number	:	253-530-8060
Fax Number	:	253-530-8062

Provider Business Practice Location Address
First Line	:	4545 POINT FOSDICK DR NW
Second Line	:	SUITE 215
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1700
Country	:	US
Telephone Number	:	253-530-8060
Fax Number	:	253-530-8062

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	05/03/2012

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Directions to “ JOHN A. KEECH JR. D.O.” Practice Location

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