Healthcare Provider Details

I. General information

NPI: 1437129855
Provider Name (Legal Business Name): GEORGE H CAUDILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1893 REDFOX ROAD
RED FOX KY
41847-0098
US

IV. Provider business mailing address

1893 REDFOX ROAD BOX 98
RED FOX KY
41847-0098
US

V. Phone/Fax

Practice location:
  • Phone: 606-642-3250
  • Fax: 606-642-3740
Mailing address:
  • Phone: 606-642-3250
  • Fax: 606-642-3740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number19066
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: