Provider Demographics
NPI:1548261225
Name:URE, KEITH J (MD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:J
Last Name:URE
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 1:1004 CAROLINE ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-3902
Mailing Address - Country:US
Mailing Address - Phone:360-457-1500
Mailing Address - Fax:360-457-1599
Practice Address - Street 1:1004 CAROLINE ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3902
Practice Address - Country:US
Practice Address - Phone:360-457-1500
Practice Address - Fax:360-157-1599
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2013-09-10
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
CAC41937174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C419370Medicaid
CA00C419370Medicaid
CA00C419370Medicare PIN