Provider Demographics
NPI:1487748364
Name:KEECH, RICHARD (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:KEECH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 E. FLORENCE AVENUE
Mailing Address - Street 2:N/A
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-5800
Mailing Address - Country:US
Mailing Address - Phone:323-935-6310
Mailing Address - Fax:310-792-2321
Practice Address - Street 1:3202 E. FLORENCE AVENUE
Practice Address - Street 2:N/A
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5800
Practice Address - Country:US
Practice Address - Phone:323-935-6310
Practice Address - Fax:310-792-2321
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29047207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A43942Medicare UPIN
CAG29047Medicare ID - Type Unspecified