Healthcare Provider Details

I. General information

NPI: 1154858611
Provider Name (Legal Business Name): DAVID DWIGHT CAUDILL CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2338 N WEST ST
LIMA OH
45801-2051
US

IV. Provider business mailing address

2338 N WEST ST
LIMA OH
45801-2051
US

V. Phone/Fax

Practice location:
  • Phone: 419-224-8000
  • Fax:
Mailing address:
  • Phone: 419-224-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number020652
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: