Provider Demographics
NPI:1952409203
Name:REMO, KEITH L (PAC)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:L
Last Name:REMO
Suffix:
Gender:M
Credentials:PAC
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Mailing Address - Street 1:3320 OAKWELL COURT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218
Mailing Address - Country:US
Mailing Address - Phone:210-829-5180
Mailing Address - Fax:210-829-5030
Practice Address - Street 1:1763 MEDICAL WAY STE B
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-4521
Practice Address - Country:US
Practice Address - Phone:210-829-5180
Practice Address - Fax:210-829-5030
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0002670363AM0700X
TXPA09393363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX348020401Medicaid
TXPA09393OtherTEXAS LICENSE
GAGRP6619Medicare PIN