Individual
DR. KEITH D WALVOORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3605 EXECUTIVE DR, SAN ANGELO, TX 76904-6884
(325) 224-5354
Mailing address
3605 EXECUTIVE DR, SAN ANGELO, TX 76904-6884
(325) 949-9555
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
G3891
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114600303
—
TX
01
—
821834
BLUECROSS/BLUE SHIELD TX
TX
Enumeration date
04/28/2006
Last updated
12/05/2018
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