Provider Demographics
NPI:1447381355
Name:KEEFER, BRENDA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LYNN
Last Name:KEEFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:LYNN
Other - Last Name:PAPPAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12641 WORLD PLAZA LN
Mailing Address - Street 2:SUITE 56
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3990
Mailing Address - Country:US
Mailing Address - Phone:239-939-2205
Mailing Address - Fax:239-939-4662
Practice Address - Street 1:12641 WORLD PLAZA LN
Practice Address - Street 2:SUITE 56
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3990
Practice Address - Country:US
Practice Address - Phone:239-939-2205
Practice Address - Fax:239-939-4662
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00589892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18426OtherBLUE CROSS
FL21772Medicare ID - Type Unspecified