MEDICARE: VINCENT CALDERON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	C8179	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11185	OTHER	AR	QUALCHOICE OF ARKANSAS
2	5J058	OTHER	AR	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1220028	OTHER	AR	UNITED HEALTH CARE NUMBER

General Provider Information

NPI Number	:	1972508513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT CALDERON M.D.

Provider Business Mailing Address
First Line	:	10301 KANIS RD STE 1
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-6205
Country	:	US
Telephone Number	:	501-224-1690
Fax Number	:	501-224-1927

Provider Business Practice Location Address
First Line	:	10301 KANIS RD STE 1
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-6205
Country	:	US
Telephone Number	:	501-562-4838
Fax Number	:	501-562-1958

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	03/04/2025

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Directions to “ VINCENT CALDERON M.D.” Practice Location

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