Provider Demographics
NPI:1972890523
Name:LOBB, KEEFE HUGO (DO)
Entity Type:Individual
Prefix:DR
First Name:KEEFE
Middle Name:HUGO
Last Name:LOBB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:11601 IRON BRIDGE RD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1466
Mailing Address - Country:US
Mailing Address - Phone:804-717-5300
Mailing Address - Fax:804-748-7269
Practice Address - Street 1:11601 IRON BRIDGE RD
Practice Address - Street 2:SUITE 117
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1466
Practice Address - Country:US
Practice Address - Phone:804-717-5300
Practice Address - Fax:804-748-7269
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0102203784207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09633OtherGROUP PTAN