Healthcare Provider Details

I. General information

NPI: 1902860935
Provider Name (Legal Business Name): JERRY M KEEFE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3424 SHELBY RAY CT
CHARLESTON SC
29414-5838
US

IV. Provider business mailing address

1818 HENDERSON ST
COLUMBIA SC
29201-2647
US

V. Phone/Fax

Practice location:
  • Phone: 843-402-6834
  • Fax: 843-573-9963
Mailing address:
  • Phone: 803-758-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15359
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: