Individual
MR. LANCE R KECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1708 YAKIMA AVE STE 102, TACOMA, WA 98405-5307
(253) 272-7777
(360) 830-1385
Mailing address
1708 YAKIMA AVE STE 102, TACOMA, WA 98405-5307
(253) 272-7777
(360) 830-1385
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60109612
WA
363AS0400X
Surgical Physician Assistant
PA01360
OR
363AS0400X
Surgical Physician Assistant
PA60109612
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0300598
L&I
WA
05
—
2007662
—
WA
01
—
G8913837
MEDICARE
WA
Enumeration date
03/03/2008
Last updated
12/04/2020
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