Provider Demographics
NPI:1063494599
Name:KEESHIN, NEAL DAVID (MD)
Entity type:Individual
Prefix:
First Name:NEAL
Middle Name:DAVID
Last Name:KEESHIN
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:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-258-3690
Mailing Address - Fax:
Practice Address - Street 1:912 32ND ST STE A
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-3473
Practice Address - Country:US
Practice Address - Phone:360-293-4343
Practice Address - Fax:360-588-1587
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10535207Q00000X
WAMD61602678207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH798923OtherMVP
VT8002134OtherLADIES FIRST
VT00019226OtherBCBS OF VT
NH30200153Medicaid
NHRE5150OtherNHIC
NH0100480OtherCIGNA
VTOVN0721Medicaid
NH0106910YPNH02OtherBCBS OF NH
NHAA61275OtherHPHC
NHF36584Medicare UPIN
VTOVN0721Medicaid