MEDICARE: REYNAL LEON CALDWELL SR. DO

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	207Q00000X	Family Medicine Physician	R5E11	MO

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	:	1972528750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REYNAL LEON CALDWELL SR. DO

Provider Business Mailing Address
First Line	:	2880 NETHERTON DR
Second Line	:	SUITE 103
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-4697
Country	:	US
Telephone Number	:	314-521-7768
Fax Number	:	314-838-3683

Provider Business Practice Location Address
First Line	:	2880 NETHERTON DR
Second Line	:	SUITE 103
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-4697
Country	:	US
Telephone Number	:	314-521-7768
Fax Number	:	314-838-3683

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	08/03/2012

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