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General NPI Number Information
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NPI Number | 1821278110
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Entity Type | Individual
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Provider Name | KEITH DAYRL CALDWELL PA
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Gender | Male
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 08/31/2009
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Provider Practice Location Address
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Address Line | 216 E BLANCO RD STE #205
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City | BOERNE
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State | TX
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Zip | 78006-2058
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Country | US
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Telephone | 830-816-2774
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Fax | 830-249-9184
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Provider Business Mailing Address
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Address Line | 10610 WIND WALKER
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City | HELOTES
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State | TX
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Zip | 78023-3852
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Country | US
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Telephone | 210-437-0882
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA02459
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License Number State | TX
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