Healthcare Provider Details

I. General information

NPI: 1023181971
Provider Name (Legal Business Name): KEVIN J CALDWELL MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 MARSHALL ST
CRESCENT CITY CA
95531
US

IV. Provider business mailing address

1240 MARSHALL ST
CRESCENT CITY CA
95531
US

V. Phone/Fax

Practice location:
  • Phone: 707-465-5566
  • Fax:
Mailing address:
  • Phone: 707-465-5566
  • Fax: 707-465-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberG42767
License Number StateCA

VIII. Authorized Official

Name: MS. MONICA ARLENE SPERLING
Title or Position: PRACTICE MANAGER
Credential: RN
Phone: 707-465-5566