Healthcare Provider Details

I. General information

NPI: 1790167203
Provider Name (Legal Business Name): ROBERT J CAULKINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ROBERT CAULKINS MD

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 PINION DR
USAF ACADEMY CO
80840-2502
US

IV. Provider business mailing address

4102 PINION DR
USAF ACADEMY CO
80840-2502
US

V. Phone/Fax

Practice location:
  • Phone: 719-524-2273
  • Fax:
Mailing address:
  • Phone: 719-524-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29699
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0070814
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: