Provider Demographics
NPI:1366622565
Name:RAYMOND E. O'KEEFE, M.D. PA
Entity type:Organization
Organization Name:RAYMOND E. O'KEEFE, M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:E
Authorized Official - Last Name:O'KEEFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-731-9600
Mailing Address - Street 1:2241 BUSH RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-5626
Mailing Address - Country:US
Mailing Address - Phone:803-731-9600
Mailing Address - Fax:803-731-0297
Practice Address - Street 1:2241 BUSH RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5626
Practice Address - Country:US
Practice Address - Phone:803-731-9600
Practice Address - Fax:803-731-0297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9550207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC095505Medicaid
SC095505Medicaid
SCB91348Medicare UPIN