Healthcare Provider Details

I. General information

NPI: 1699730713
Provider Name (Legal Business Name): GEORGE L CALDWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 W CYPRESS CREEK RD STE 200
FORT LAUDERDALE FL
33309-1866
US

IV. Provider business mailing address

2122 W CYPRESS CREEK RD STE 200
FORT LAUDERDALE FL
33309-1866
US

V. Phone/Fax

Practice location:
  • Phone: 954-358-9474
  • Fax: 954-686-2687
Mailing address:
  • Phone: 954-358-9474
  • Fax: 954-686-2687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME66694
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberME66694
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: