Provider Demographics
NPI:1700878881
Name:KEFFER, SCOTT A (DO)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:KEFFER
Suffix:
Gender:M
Credentials:DO
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 A
Mailing Address - Street 2:123 JAMES RIVER & KANAWHA TURNPIKE
Mailing Address - City:ANSTED
Mailing Address - State:WV
Mailing Address - Zip Code:25812-1401
Mailing Address - Country:US
Mailing Address - Phone:855-250-3054
Mailing Address - Fax:304-658-4690
Practice Address - Street 1:123 JAMES RIVER AND KANAWHA TURNPIKE
Practice Address - Street 2:
Practice Address - City:ANSTED
Practice Address - State:WV
Practice Address - Zip Code:25812-1401
Practice Address - Country:US
Practice Address - Phone:855-250-3054
Practice Address - Fax:304-658-4690
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1615207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0047889000Medicaid
WV0047889000Medicaid
WV4288111Medicare PIN