Healthcare Provider Details

I. General information

NPI: 1518274521
Provider Name (Legal Business Name): DOUGLAS F C KEFFER PH D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5440 PETERS CREEK RD SUITE 103
ROANOKE VA
24019-3862
US

IV. Provider business mailing address

5440 PETERS CREEK RD SUITE 103
ROANOKE VA
24019-3862
US

V. Phone/Fax

Practice location:
  • Phone: 540-562-5068
  • Fax: 540-562-5069
Mailing address:
  • Phone: 540-562-5068
  • Fax: 540-562-5069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: