Provider Demographics
NPI:1013993351
Name:SCHREFFLER, KEITH R JR (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:R
Last Name:SCHREFFLER
Suffix:JR
Gender:M
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:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IN
Mailing Address - Zip Code:46733-0151
Mailing Address - Country:US
Mailing Address - Phone:260-724-2145
Mailing Address - Fax:317-957-2750
Practice Address - Street 1:1316 E 7TH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-2523
Practice Address - Country:US
Practice Address - Phone:260-925-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045385A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN930106016OtherRAILROAD MEDICARE
IN200040710AMedicaid
IN000000191937OtherANTHEM BC/BS
IN200040710AMedicaid
IN000000191937OtherANTHEM BC/BS