Healthcare Provider Details

I. General information

NPI: 1629539937
Provider Name (Legal Business Name): JARRYD ADAM KEFFLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CHILDRENS AVE
OKLAHOMA CITY OK
73104-4637
US

IV. Provider business mailing address

1500 CORDGRASS CT
EDMOND OK
73013-2142
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-2429
  • Fax: 405-271-2421
Mailing address:
  • Phone: 303-359-7083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number41505
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number333841
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: