Provider Demographics
NPI:1558326264
Name:KEEFE, HARRY R (MD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:R
Last Name:KEEFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1600 N GRAND AVE
Mailing Address - Street 2:STE 310
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2700
Mailing Address - Country:US
Mailing Address - Phone:719-542-0072
Mailing Address - Fax:719-542-9888
Practice Address - Street 1:1600 N GRAND AVE
Practice Address - Street 2:STE 310
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2700
Practice Address - Country:US
Practice Address - Phone:719-542-0072
Practice Address - Fax:719-542-9888
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO25438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D24633Medicare UPIN