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General NPI Number Information
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NPI Number | 1750550489
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Entity Type | Organization
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Legal Business Name | FOOT CARE OF NORTHEAST ARKANSAS PA
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Dates
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Enumeration Date | 02/27/2008
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Last Update Date | 08/28/2008
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Provider Practice Location Address
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Address Line | 406 E WASHINGTON AVE
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City | JONESBORO
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State | AR
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Zip | 72401-3108
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Country | US
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Telephone | 870-933-8900
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Fax | 870-933-2611
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Provider Business Mailing Address
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Address Line | PO BOX 1984
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City | JONESBORO
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State | AR
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Zip | 72403-1984
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Country | US
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Telephone | 870-933-8900
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Fax | 870-933-2611
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDDY LLOYD CALDWELL
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Credential | DPM
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Telephone | 870-933-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | AR163
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License Number State | AR
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