Dr Mark Allen Keller, MD | |
7205 265th St Nw, Stanwood, WA 98292-6221 | |
(360) 629-1500 | |
Not Available |
Full Name | Dr Mark Allen Keller |
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Gender | Male |
Speciality | Pediatrics |
Location | 7205 265th St Nw, Stanwood, Washington |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1497138861 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | MT209962 (Pennsylvania) | Secondary |
208000000X | Pediatrics | MD61049864 (Washington) | Primary |
Entity Name | The Polyclinic |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1174594634 PECOS PAC ID: 2163328196 Enrollment ID: O20031210000788 |
Entity Name | Optum Care Washington Pllc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1831186766 PECOS PAC ID: 6406752153 Enrollment ID: O20031211000922 |
Mailing Address | Practice Location Address |
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Dr Mark Allen Keller, MD 10020 15th Pl Se, Lake Stevens, WA 98258-3830 Ph: (610) 392-7647 | Dr Mark Allen Keller, MD 7205 265th St Nw, Stanwood, WA 98292-6221 Ph: (360) 629-1500 |
James Troutman, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 7205 265th St Nw, Stanwood, WA 98292 Phone: 360-629-1502 Fax: 360-629-1524 | |
Dr. Susana E Myers, DO Pediatrics Medicare: Medicare Enrolled Practice Location: 7205 265th St Nw, Stanwood, WA 98292 Phone: 425-258-3900 | |
Dr. Arnold Andre Ronning, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 9631 269th St Nw, Stanwood, WA 98292 Phone: 425-870-7384 |