Healthcare Provider Details

I. General information

NPI: 1043296148
Provider Name (Legal Business Name): KAE PATRICK MCCAFFERY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6190 BARNES ROAD
COLORADO SPRINGS CO
80922-2600
US

IV. Provider business mailing address

6190 BARNES ROAD
COLORADO SPRINGS CO
80922-2600
US

V. Phone/Fax

Practice location:
  • Phone: 719-596-4502
  • Fax: 719-597-2668
Mailing address:
  • Phone: 719-596-4502
  • Fax: 719-597-2668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23771
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: