Provider Demographics
NPI:1720053739
Name:CALDERON, GUIDO (MD)
Entity type:Individual
Prefix:
First Name:GUIDO
Middle Name:
Last Name:CALDERON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310682
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78131-0682
Mailing Address - Country:US
Mailing Address - Phone:830-620-0330
Mailing Address - Fax:830-620-5405
Practice Address - Street 1:1619 E COMMON ST STE 1201
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3464
Practice Address - Country:US
Practice Address - Phone:830-620-0330
Practice Address - Fax:830-620-5405
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4008208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8W2432OtherBC/BS
TX120666614Medicaid
G37564Medicare UPIN
TX8F4305Medicare PIN
P00394968Medicare PIN