Healthcare Provider Details

I. General information

NPI: 1952392532
Provider Name (Legal Business Name): RICHARD THOMAS CALDWELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OPELOUSAS STREET
LAKE CHARLES LA
70601
US

IV. Provider business mailing address

2000 OPELOUSAS STREET
LAKE CHARLES LA
70601
US

V. Phone/Fax

Practice location:
  • Phone: 337-439-9983
  • Fax:
Mailing address:
  • Phone: 337-439-9983
  • Fax: 337-310-1161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberF3804
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24446
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF3804
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number24446
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2014-0048
License Number StateNM
# 6
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number2014-0048
License Number StateNM
# 7
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.207803
License Number StateLA
# 8
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberMD.207803
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: