Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 1909 | TX |
NPI | 1174515589 |
---|---|
Provider Name | Dr. Caroline Diane Gaynor |
First Address | San Antonio, TX 78251-4504 |
Second Address | San Antonio, TX 78217-5215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2005 |
Last Update Date | 03/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
215975801 | (05) | TX |
8BT931 | BCBS (01) | TX |