Provider Demographics
NPI:1467415133
Name:KEFFER, AMY LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LYNN
Last Name:KEFFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N MCKINNEY ST STE B
Mailing Address - Street 2:
Mailing Address - City:SWEENY
Mailing Address - State:TX
Mailing Address - Zip Code:77480-2808
Mailing Address - Country:US
Mailing Address - Phone:979-548-1875
Mailing Address - Fax:979-548-1873
Practice Address - Street 1:303 N MCKINNEY ST STE B
Practice Address - Street 2:
Practice Address - City:SWEENY
Practice Address - State:TX
Practice Address - Zip Code:77480-2808
Practice Address - Country:US
Practice Address - Phone:979-548-1875
Practice Address - Fax:979-548-1873
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4099207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097553406Medicaid
TX83Y419OtherBC/BS TX#
TX097553402Medicaid
TX110129980OtherRAILROAD GBA - RAILROAD MEDICARE
TX8DE532OtherBC/BS #
TX8DE532OtherBC/BS #
TX110129980OtherRAILROAD GBA - RAILROAD MEDICARE
TXD87455Medicare UPIN