Individual
DR. SCOTT JAMES KECKLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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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