Provider Demographics
NPI:1205855004
Name:O'KEEFFE, JOHN S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:O'KEEFFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8890 N UNION BLVD STE 170
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-2701
Mailing Address - Country:US
Mailing Address - Phone:719-364-5005
Mailing Address - Fax:719-365-9911
Practice Address - Street 1:8890 NORTH UNION BLVD
Practice Address - Street 2:SUITE 170
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-2701
Practice Address - Country:US
Practice Address - Phone:719-364-5005
Practice Address - Fax:719-365-9911
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO30329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01303296Medicaid
CO493868Medicare PIN
CO01303296Medicaid