Provider Demographics
NPI:1033169222
Name:CALDERA, FREDDY J (MD)
Entity Type:Individual
Prefix:
First Name:FREDDY
Middle Name:J
Last Name:CALDERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 MINOLA DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6036
Mailing Address - Country:US
Mailing Address - Phone:305-649-6111
Mailing Address - Fax:305-649-1448
Practice Address - Street 1:480 MINOLA DR
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-6036
Practice Address - Country:US
Practice Address - Phone:305-649-6111
Practice Address - Fax:305-649-1448
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 50220208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061642700Medicaid
FL650127333OtherTAX IDENTIFICATION NUMBER
FLD061004Medicare UPIN
FL061642700Medicaid