Provider Demographics
NPI:1487618294
Name:KEFFER, GREGORY LANE (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LANE
Last Name:KEFFER
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 1:2100 REGIONAL MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-9719
Mailing Address - Country:US
Mailing Address - Phone:979-532-1700
Mailing Address - Fax:979-532-4584
Practice Address - Street 1:111 AVENUE F
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-4117
Practice Address - Country:US
Practice Address - Phone:979-245-9754
Practice Address - Fax:979-244-3750
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3086207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPO1209193OtherRAILROAD MEDICARE #
TX114508802Medicaid
TX160039179OtherRAILROAD GBA - RAILROAD MEDICARE
TX83Y420OtherBC/BS TX#
TX114508806Medicaid
TX8DE531OtherBC/BS #
TX160039179OtherRAILROAD GBA - RAILROAD MEDICARE
TXB23884Medicare UPIN
TX83Y420Medicare ID - Type Unspecified