Provider Demographics
NPI:1184672974
Name:KEEFER, BRADLEY JAMES (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:JAMES
Last Name:KEEFER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 SAWTELL RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-7873
Mailing Address - Country:US
Mailing Address - Phone:843-390-1333
Mailing Address - Fax:843-390-1633
Practice Address - Street 1:3700 SAWTELL RD
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-7873
Practice Address - Country:US
Practice Address - Phone:843-390-1333
Practice Address - Fax:843-390-1633
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC546213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC780806UMedicaid
SCPD5462Medicaid
SCU85430Medicare UPIN