Provider Demographics
NPI:1023113735
Name:SEALE, JEFFREY KEEFE (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:KEEFE
Last Name:SEALE
Suffix:
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 808
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-0808
Mailing Address - Country:US
Mailing Address - Phone:601-703-4920
Mailing Address - Fax:601-703-4921
Practice Address - Street 1:1800 12TH ST
Practice Address - Street 2:SUITE 4A
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4158
Practice Address - Country:US
Practice Address - Phone:601-703-4920
Practice Address - Fax:601-703-4921
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19028207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03039077Medicaid
MS03039077Medicaid