Provider Demographics
NPI:1619957503
Name:KEEFE, LYNN M (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:M
Last Name:KEEFE
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 1:2006 N PARTIN DRIVE
Mailing Address - Street 2:BLDG 300 STE 320
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578
Mailing Address - Country:US
Mailing Address - Phone:850-279-6260
Mailing Address - Fax:
Practice Address - Street 1:2600 PARTIN DR N
Practice Address - Street 2:BLDG 300 SUITE 320
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1542
Practice Address - Country:US
Practice Address - Phone:850-279-6260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0056741208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
12637OtherBLUE SHIELD
FL054405100Medicaid
12637OtherBLUE SHIELD