Provider Demographics
NPI:1235102096
Name:CAUGHFIELD, DWIGHT KEITHER (MD)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:KEITHER
Last Name:CAUGHFIELD
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 1:9098 DEIFENDEFFER
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:CO
Mailing Address - Zip Code:81069
Mailing Address - Country:US
Mailing Address - Phone:719-545-7802
Mailing Address - Fax:719-545-7804
Practice Address - Street 1:511 W 29TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1128
Practice Address - Country:US
Practice Address - Phone:719-545-7802
Practice Address - Fax:719-545-7804
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30495208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01304955Medicaid
CO01304955Medicaid
COF63569Medicare UPIN