Healthcare Provider Details

I. General information

NPI: 1245296177
Provider Name (Legal Business Name): CHARLES B. CAULDWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 PARNASSUS AVE C 450
SAN FRANCISCO CA
94143-0648
US

IV. Provider business mailing address

521 PARNASSUS AVE C 450
SAN FRANCISCO CA
94143-0648
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-0836
  • Fax: 415-476-9516
Mailing address:
  • Phone: 415-476-0836
  • Fax: 415-476-9516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG62215
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG62215
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: