Provider Demographics
NPI:1821278110
Name:CALDWELL, KEITH DAYRL (PA)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:DAYRL
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10610 WIND WALKER
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-3852
Mailing Address - Country:US
Mailing Address - Phone:210-437-0882
Mailing Address - Fax:
Practice Address - Street 1:216 E BLANCO RD
Practice Address - Street 2:STE #205
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2058
Practice Address - Country:US
Practice Address - Phone:830-816-2774
Practice Address - Fax:830-249-9184
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02459363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant