Provider Demographics
NPI:1558509794
Name:JASON R. KEIFER, M.D., P.C., LLC
Entity Type:Organization
Organization Name:JASON R. KEIFER, M.D., P.C., LLC
Other - Org Name:BRAIN HEALTH HAWAII
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS & FINANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FREITAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-554-5688
Mailing Address - Street 1:4211 WAIALAE AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5312
Mailing Address - Country:US
Mailing Address - Phone:808-554-5688
Mailing Address - Fax:808-888-5690
Practice Address - Street 1:4211 WAIALAE AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5319
Practice Address - Country:US
Practice Address - Phone:808-542-7349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD129872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty