Provider Demographics
NPI:1043296148
Name:MCCAFFERY, KAE PATRICK (DO)
Entity type:Individual
Prefix:
First Name:KAE
Middle Name:PATRICK
Last Name:MCCAFFERY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6190 BARNES ROAD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-2600
Mailing Address - Country:US
Mailing Address - Phone:719-596-4502
Mailing Address - Fax:719-597-2668
Practice Address - Street 1:6190 BARNES ROAD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-2600
Practice Address - Country:US
Practice Address - Phone:719-596-4502
Practice Address - Fax:719-597-2668
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23771208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01237718Medicaid