Healthcare Provider Details

I. General information

NPI: 1679673420
Provider Name (Legal Business Name): JUDY L. CALDWELL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 E 100 S STE 17B
SAINT GEORGE UT
84790-3074
US

IV. Provider business mailing address

1240 E 100 S STE 17B
SAINT GEORGE UT
84790-3074
US

V. Phone/Fax

Practice location:
  • Phone: 435-703-9499
  • Fax: 435-477-6990
Mailing address:
  • Phone: 435-703-9499
  • Fax: 435-477-6990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO1441
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number9897237-1204
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number9897237-1204
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A6927
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9897237-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: