MEDICARE: DR. BRADLEY JAMES KEEFER DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0131X	Foot Surgery Podiatrist	546	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184672974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY JAMES KEEFER DPM

Provider Business Mailing Address
First Line	:	3700 SAWTELL RD
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-7873
Country	:	US
Telephone Number	:	843-390-1333
Fax Number	:	843-390-1633

Provider Business Practice Location Address
First Line	:	3700 SAWTELL RD
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-7873
Country	:	US
Telephone Number	:	843-390-1333
Fax Number	:	843-390-1633

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	02/24/2010

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