MEDICARE: CARA MARIE CADDELL 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	208000000X	Pediatrics Physician	MD26557	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902855943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARA MARIE CADDELL M.D.

Provider Business Mailing Address
First Line	:	254 NE NORTON LN
Second Line	:
City	:	MCMINNVILLE
State	:	OR
Zip	:	97128-8470
Country	:	US
Telephone Number	:	503-472-6161
Fax Number	:	503-434-6290

Provider Business Practice Location Address
First Line	:	254 NE NORTON LN
Second Line	:
City	:	MCMINNVILLE
State	:	OR
Zip	:	97128-8470
Country	:	US
Telephone Number	:	503-472-6161
Fax Number	:	503-434-6290

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	11/07/2007

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