Provider Demographics
NPI:1114987658
Name:KEEFE, KELLY SHANNON (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:SHANNON
Last Name:KEEFE
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Gender:F
Credentials:MD
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Mailing Address - Street 1:3969 4TH AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103
Mailing Address - Country:US
Mailing Address - Phone:619-291-6191
Mailing Address - Fax:619-291-0049
Practice Address - Street 1:3969 4TH AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-532-6702
Practice Address - Fax:619-532-7272
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2012-03-19
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Provider Licenses
StateLicense IDTaxonomies
CAA48069207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology