Healthcare Provider Details

I. General information

NPI: 1235131640
Provider Name (Legal Business Name): EDDY LLOYD CALDWELL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 E WASHINGTON AVE
JONESBORO AR
72401-3108
US

IV. Provider business mailing address

PO BOX 1984
JONESBORO AR
72403-1984
US

V. Phone/Fax

Practice location:
  • Phone: 870-933-8900
  • Fax: 870-933-2611
Mailing address:
  • Phone: 870-933-8900
  • Fax: 870-933-2611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberAR-163
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: