Keckley, W. Dale

Keckley, W. Dale is an individual health care provider with primary practice located at 263 Farmington Ave General Surgery, Farmington CT 06030-6227. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as his primary health care specialty. Keckley, W. Dale can be contacted via phone (860) 679-8080.

Contact Information

Primary practice address
263 Farmington Ave General Surgery Farmington CT 06030-6227
Phone: (860) 679-8080
Fax: (860) 679-1420
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 001065 Connecticut

Profile Details

NPI number 1336126259
LBN Legal business name Keckley, W. Dale
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 30th, 2005
Last updated Sep 11th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336126259 NPPES
Connecticut MEDICAID 1336126259

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