Healthcare Provider Details

I. General information

NPI: 1912248873
Provider Name (Legal Business Name): BRADLEY A KEFFER PS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 N ELDORADO AVE
KLAMATH FALLS OR
97601-6423
US

IV. Provider business mailing address

2545 N ELDORADO AVE
KLAMATH FALLS OR
97601-6423
US

V. Phone/Fax

Practice location:
  • Phone: 541-883-3471
  • Fax: 541-883-3524
Mailing address:
  • Phone: 541-883-3471
  • Fax: 541-883-3524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: