Provider Demographics
NPI:1164461745
Name:JEFFREY, KEITH A (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:A
Last Name:JEFFREY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 MOWRY AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1716
Mailing Address - Country:US
Mailing Address - Phone:510-818-7200
Mailing Address - Fax:510-742-9334
Practice Address - Street 1:2000 MOWRY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1716
Practice Address - Country:US
Practice Address - Phone:510-818-7200
Practice Address - Fax:510-742-9334
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16317363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP53511Medicare UPIN
CAZZZ49013ZMedicare ID - Type UnspecifiedFREMONT ORTHOPAEDIC'S #