Provider Demographics
NPI:1518545748
Name:O'KEEFE, LAURA JOANN
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JOANN
Last Name:O'KEEFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SAMCC, MCHE-ZDM-M, INTERNAL MEDICINE RESIDENCY
Mailing Address - Street 2:3551 ROGER BROOKE DR.
Mailing Address - City:JBSA-FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-292-7805
Mailing Address - Fax:210-292-7868
Practice Address - Street 1:SAMCC, MCHE-ZDM-M, INTERNAL MEDICINE RESIDENCY
Practice Address - Street 2:3551 ROGER BROOKE DR.
Practice Address - City:JBSA-FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-292-7805
Practice Address - Fax:210-292-7868
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101276725208D00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice