Provider Demographics
NPI:1962527911
Name:JEFFREY A. KLEM, MD, PA
Entity type:Organization
Organization Name:JEFFREY A. KLEM, MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KLEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-835-1200
Mailing Address - Street 1:PO BOX 2952
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77704-2952
Mailing Address - Country:US
Mailing Address - Phone:409-835-1200
Mailing Address - Fax:
Practice Address - Street 1:3160 FANNIN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3948
Practice Address - Country:US
Practice Address - Phone:409-835-1200
Practice Address - Fax:409-835-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2379207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty