Healthcare Provider Details

I. General information

NPI: 1770688038
Provider Name (Legal Business Name): KEITH JAMES KEEFER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT 72 E
NEW LISBON NJ
08064
US

IV. Provider business mailing address

11 PENNS LNDG S
PHILADELPHIA PA
19147-4351
US

V. Phone/Fax

Practice location:
  • Phone: 609-894-4005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA0293100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: