Individual
MR. ELLIOTT SPENCER KECK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
1550 TOMCAT BLVD STE 150, NAS OCEANA, BHC, VIRGINIA BEACH, VA 23460-2186
(757) 953-3792
Mailing address
1550 TOMCAT BLVD STE 150, NAS OCEANA, BHC, VIRGINIA BEACH, VA 23460-2186
(757) 953-3792
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
247200000X
Other Technician
—
—
Other
Enumeration date
06/15/2007
Last updated
07/18/2012
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