Healthcare Provider Details

I. General information

NPI: 1467415133
Provider Name (Legal Business Name): AMY LYNN KEFFER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N MCKINNEY ST STE B
SWEENY TX
77480-2808
US

IV. Provider business mailing address

303 N MCKINNEY ST STE B
SWEENY TX
77480-2808
US

V. Phone/Fax

Practice location:
  • Phone: 979-548-1875
  • Fax: 979-548-1873
Mailing address:
  • Phone: 979-548-1875
  • Fax: 979-548-1873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberH4099
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: