MEDICARE: DR. FRANK JAY KEEFER MD

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	207VG0400X	Gynecology Physician	183733-1205	UT
2	207VG0400X	Gynecology Physician	35.027196	OH

General Provider Information

NPI Number	:	1255636981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRANK JAY KEEFER MD

Provider Business Mailing Address
First Line	:	3324 SEVEN SPRINGS DR
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84092-4560
Country	:	US
Telephone Number	:	801-942-3510
Fax Number	:

Provider Business Practice Location Address
First Line	:	3324 SEVEN SPRINGS DR
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84092-4560
Country	:	US
Telephone Number	:	801-942-3510
Fax Number	:

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

Provider Enumeration Date	:	01/11/2011
Last Update Date	:	01/11/2011

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