Healthcare Provider Details

I. General information

NPI: 1922008192
Provider Name (Legal Business Name): JOHN D CAGGIANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W COUNTRY CLUB RD SUITE #130
ROSWELL NM
88201-5240
US

IV. Provider business mailing address

300 W COUNTRY CLUB RD SUITE #130
ROSWELL NM
88201-5240
US

V. Phone/Fax

Practice location:
  • Phone: 575-624-4777
  • Fax: 575-624-8711
Mailing address:
  • Phone: 575-624-4777
  • Fax: 575-624-8711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD012076
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD2012-0238
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: