Individual
W. DALE KECKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
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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