Provider Demographics
NPI:1225149925
Name:O'KEEFE, RAYMOND E (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:E
Last Name:O'KEEFE
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 1:2241 BUSH RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-5626
Mailing Address - Country:US
Mailing Address - Phone:803-731-9600
Mailing Address - Fax:803-731-0297
Practice Address - Street 1:2241 BUSH RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5626
Practice Address - Country:US
Practice Address - Phone:803-731-9600
Practice Address - Fax:803-731-0297
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9550207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC095505Medicaid
SCB913487400Medicare PIN
SCB91348Medicare UPIN