Healthcare Provider Details

I. General information

NPI: 1346255221
Provider Name (Legal Business Name): HENRY H KALDENBAUGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 S MAIN ST
COTTONWOOD AZ
86326-3907
US

IV. Provider business mailing address

214 S MAIN ST
COTTONWOOD AZ
86326-3907
US

V. Phone/Fax

Practice location:
  • Phone: 928-634-7534
  • Fax:
Mailing address:
  • Phone: 928-634-7534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7977
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number7977
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number7977
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7977
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: