Healthcare Provider Details

I. General information

NPI: 1093003808
Provider Name (Legal Business Name): HANNAH ELIZABETH CAULFIELD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 04/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 HOSPITAL WAY #201
POCATELLO ID
83201-5175
US

IV. Provider business mailing address

PO BOX 4168
POCATELLO ID
83205-4168
US

V. Phone/Fax

Practice location:
  • Phone: 208-239-2620
  • Fax: 208-239-3778
Mailing address:
  • Phone: 208-239-2620
  • Fax: 208-239-3778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR72636
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberM13122
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: