MEDICARE: BROOKE CALDWELL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	A46292	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A462920	OTHER	CA	BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134176969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE CALDWELL M.D.

Provider Business Mailing Address
First Line	:	5725 W LAS POSITAS BLVD
Second Line	:
City	:	PLEASANTON
State	:	CA
Zip	:	94588-4054
Country	:	US
Telephone Number	:	925-416-6789
Fax Number	:	925-416-6758

Provider Business Practice Location Address
First Line	:	5725 W LAS POSITAS BLVD
Second Line	:
City	:	PLEASANTON
State	:	CA
Zip	:	94588-4054
Country	:	US
Telephone Number	:	925-416-6789
Fax Number	:	925-416-6758

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	05/16/2023

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