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General NPI Number Information
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NPI Number | 1780670513
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Entity Type | Individual
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Provider Name | ALBERT G CACCAVALE DO
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Gender | Male
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 02/22/2018
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Provider Practice Location Address
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Address Line | 1003 WILLOW CREEK RD
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City | PRESCOTT
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State | AZ
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Zip | 86301-1641
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Country | US
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Telephone | 928-771-5420
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Fax | 928-771-5471
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Provider Business Mailing Address
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Address Line | PO BOX 11720
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City | PRESCOTT
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State | AZ
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Zip | 86304-1720
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Country | US
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Telephone | 928-771-5487
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Fax | 928-771-5471
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 47673
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 1944
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 1944
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License Number State | AZ
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