MEDICARE: BERNIE M CALDWELL PA-C

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	363A00000X	Physician Assistant	PA.A10383.RX	LA

General Provider Information

NPI Number	:	1164407896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNIE M CALDWELL PA-C

Provider Business Mailing Address
First Line	:	10319 JEFFERSON HWY
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-2730
Country	:	US
Telephone Number	:	225-241-9935
Fax Number	:	225-367-1060

Provider Business Practice Location Address
First Line	:	3424 CYPRESS ST
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-7310
Country	:	US
Telephone Number	:	318-450-4626
Fax Number	:	318-600-4078

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	03/20/2020

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