Provider Demographics
NPI:1174515589
Name:GAYNOR, CAROLINE DIANE (DPM)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:DIANE
Last Name:GAYNOR
Suffix:
Gender:
Credentials:DPM
Other - Prefix:DR
Other - First Name:CAROLINE
Other - Middle Name:DIANE
Other - Last Name:GAYNOR-ELKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:11212 STATE HWY 151, MEDICAL PLAZA 1 STE. 370
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4504
Mailing Address - Country:US
Mailing Address - Phone:210-664-4700
Mailing Address - Fax:210-314-1771
Practice Address - Street 1:11212 STATE HWY 151, MEDICAL PLAZA 1 STE. 370
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4504
Practice Address - Country:US
Practice Address - Phone:210-664-4700
Practice Address - Fax:210-314-1771
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1909213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BT931OtherBCBS
TX215975801Medicaid
TX8BT931OtherBCBS