Provider Demographics
NPI:1033193297
Name:KETTING, CASE H (MD)
Entity type:Individual
Prefix:
First Name:CASE
Middle Name:H
Last Name:KETTING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1081 SE CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:99324-1688
Mailing Address - Country:US
Mailing Address - Phone:805-550-5816
Mailing Address - Fax:
Practice Address - Street 1:1713 SW 24TH ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-4330
Practice Address - Country:US
Practice Address - Phone:541-304-2264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71886174400000X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G718860Medicaid
CAF61205Medicare UPIN
CAWG71886DMedicare ID - Type Unspecified
CA00G718860Medicaid
CABH221ZMedicare PIN