Individual
DR. SCOTT JAMES KECKLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1600 W 22ND ST, SIOUX FALLS, SD 57105-1521
(605) 312-1000
(605) 312-1001
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
2012024116
MO
2086S0120X
Pediatric Surgery Physician
Primary
11615
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154597011
—
MO
05
—
193951001
—
AR
01
—
431560263
TRICARE
MO
01
—
P01089889
RR MCR
MO
Enumeration date
05/01/2008
Last updated
02/10/2020
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