Individual
DR. HENRY CALDERONI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5055 MCNUTT RD, SANTA TERESA, NM 88008-9442
(575) 589-5005
(575) 589-1333
Mailing address
5055 MCNUTT RD, SANTA TERESA, NM 88008-9442
(575) 589-5005
(575) 589-1333
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
80-18
NM
207Q00000X
Family Medicine Physician
F8430
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000G6207
—
NM
01
—
080166729
PALMETTO GBA
TX
05
—
115519404
—
TX
01
—
476935ZS5H
WELLMED PTAN
NM
05
—
908609J10
—
TX
Enumeration date
11/04/2005
Last updated
06/15/2016
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