=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235131640
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDDY LLOYD CALDWELL DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2005
-----------------------------------------------------
Last Update Date | 11/02/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 406 E WASHINGTON AVE
-----------------------------------------------------
City | JONESBORO
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72401-3108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-933-8900
-----------------------------------------------------
Fax | 870-933-2611
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1984
-----------------------------------------------------
City | JONESBORO
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72403-1984
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-933-8900
-----------------------------------------------------
Fax | 870-933-2611
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | AR-163
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------