Healthcare Provider Details

I. General information

NPI: 1073906459
Provider Name (Legal Business Name): JOHN WILLIAM KIEFFER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2015
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 3215
APO AE
09094-3215
US

IV. Provider business mailing address

UNIT 3215
APO AE
09094-3215
US

V. Phone/Fax

Practice location:
  • Phone: 637-146-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number0101260992
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: