Active NPI
Keith D Walvoord, MD
- Otolaryngology Physician
- San Angelo, TX
National Provider Identifier
1013974583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- G3891
- Practice address
- 3605 Executive Dr
San Angelo, TX 76904-6884 - Phone
- (325) 224-5354
- NPI assigned
- Apr 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | G3891 | TX | Primary |
Addresses
Primary practice location
3605 Executive Dr
San Angelo, TX 76904-6884
Mailing address
3605 Executive Dr
San Angelo, TX 76904-6884
Phone (325) 949-9555
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 114600303 | Medicaid | TX | |
| 821834 | Other | TX | BLUECROSS/BLUE SHIELD TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146182400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1543968000000",
"number": "1013974583",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3605 EXECUTIVE DR",
"city": "SAN ANGELO",
"state": "TX",
"postal_code": "769046884",
"telephone_number": "325-949-9555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3605 EXECUTIVE DR",
"city": "SAN ANGELO",
"state": "TX",
"postal_code": "769046884",
"telephone_number": "325-224-5354"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALVOORD",
"first_name": "KEITH",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-28",
"last_updated": "2018-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "TX",
"license": "G3891",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "114600303",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS/BLUE SHIELD TX",
"identifier": "821834",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Angelo, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.