Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 1131 | SC |
NPI | 1013980168 |
---|---|
Provider Name | Dr. James Reilly Keffer |
First Address | Charlotte, NC 28275-1649 |
Second Address | Charleston, SC 29414-5893 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 25/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
011310 | (05) | SC |
I27962 | (02) | SC |
P00817217 | RR MEDICARE (01) | SC |