Healthcare Provider Details

I. General information

NPI: 1326269101
Provider Name (Legal Business Name): JEFFREY L KEARFOTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 SOUTH BURNETT
SPRINGFIELD OH
45505
US

IV. Provider business mailing address

20 SOUTH BURNETT
SPRINGFIELD OH
45505
US

V. Phone/Fax

Practice location:
  • Phone: 937-325-6363
  • Fax: 937-325-7262
Mailing address:
  • Phone: 937-325-6363
  • Fax: 937-325-7262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35055570K
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: