Provider Demographics
NPI:1013980168
Name:KEFFER, JAMES REILLY (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:REILLY
Last Name:KEFFER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:REILLY
Other - Middle Name:
Other - Last Name:KEFFER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:2145 HENRY TECKLENBURG DR
Practice Address - Street 2:STE 220
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5893
Practice Address - Country:US
Practice Address - Phone:843-723-8823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1131208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC011310Medicaid
SCP00817217OtherRR MEDICARE
SCI27962Medicare UPIN
SCAA24263640Medicare PIN
SC011310Medicaid
SCP00817217OtherRR MEDICARE
SCAA24267951Medicare PIN