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General NPI Number Information
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NPI Number | 1205842887
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Entity Type | Individual
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Provider Name | JEFFREY KEITH ARBUCKLE M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 12/27/2018
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Provider Practice Location Address
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Address Line | 2859 VIRGINIA BEACH BLVD STE 108
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-7622
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Country | US
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Telephone | 757-644-4615
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Fax | 757-440-3921
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Provider Business Mailing Address
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Address Line | 2859 VIRGINIA BEACH BLVD STE 108
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-7622
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Country | US
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Telephone | 757-644-4615
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Fax | 757-440-3921
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101222201
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License Number State | VA
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