Provider Demographics
NPI:1205842887
Name:ARBUCKLE, JEFFREY KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:KEITH
Last Name:ARBUCKLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2859 VIRGINIA BEACH BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7622
Mailing Address - Country:US
Mailing Address - Phone:757-644-4615
Mailing Address - Fax:757-440-3921
Practice Address - Street 1:2859 VIRGINIA BEACH BLVD STE 108
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7622
Practice Address - Country:US
Practice Address - Phone:757-644-4615
Practice Address - Fax:757-440-3921
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101222201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAF27016Medicare UPIN
VA080007554Medicare PIN