Provider Demographics
NPI:1003060294
Name:O'KEEFFE, SHANE DAMIEN (MD)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:DAMIEN
Last Name:O'KEEFFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2697
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-7697
Mailing Address - Country:US
Mailing Address - Phone:270-796-3330
Mailing Address - Fax:270-796-3338
Practice Address - Street 1:350 PARK ST
Practice Address - Street 2:SUITE 210
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1784
Practice Address - Country:US
Practice Address - Phone:270-796-3330
Practice Address - Fax:270-796-3338
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY430212086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000779824OtherBCBS
KY7100143600Medicaid
KY43021OtherLICENSE
KY7100143600Medicaid