Individual
W. DALE KECKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
263 FARMINGTON AVE, GENERAL SURGERY, FARMINGTON, CT 06030-6227
(860) 679-8080
(860) 679-1420
Mailing address
263 FARMINGTON AVE, PROVIDER ENROLLMENT, FARMINGTON, CT 06030-2212
(860) 679-7503
(860) 679-1610
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
001065
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336126259
—
CT
Enumeration date
12/30/2005
Last updated
09/11/2012
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