Healthcare Provider Details

I. General information

NPI: 1174901714
Provider Name (Legal Business Name): RYAN MICHAEL CAULFIELD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 DELAWARE ST
LONGVIEW WA
98632-2367
US

IV. Provider business mailing address

1615 DELAWARE ST
LONGVIEW WA
98632-2367
US

V. Phone/Fax

Practice location:
  • Phone: 360-636-4830
  • Fax:
Mailing address:
  • Phone: 360-636-4830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOP60856588
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101021682
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDR.0067876
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: