Individual
MR. LEROY KEITH VAN DYKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3322 ROAD N NE, MOSES LAKE, WA 98837-9505
(509) 793-9051
(509) 766-8585
Mailing address
3322 ROAD N NE, MOSES LAKE, WA 98837-9505
(509) 793-9051
(509) 766-8585
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10003296
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8421323
—
WA
Enumeration date
06/23/2005
Last updated
01/18/2024
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