Provider Demographics
NPI:1235131640
Name:CALDWELL, EDDY LLOYD (DPM)
Entity Type:Individual
Prefix:DR
First Name:EDDY
Middle Name:LLOYD
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1984
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-1984
Mailing Address - Country:US
Mailing Address - Phone:870-933-8900
Mailing Address - Fax:870-933-2611
Practice Address - Street 1:406 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3108
Practice Address - Country:US
Practice Address - Phone:870-933-8900
Practice Address - Fax:870-933-2611
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR-163213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR130246748OtherCLINIC NUMBER
AR167681748OtherMEDICAID CLINIC
AR130109717Medicaid
AR5T344F963OtherMEDICARE CLLINIC
AR480034780OtherRR MEDICARE
AR5T344F963OtherMEDICARE CLLINIC
AR130246748OtherCLINIC NUMBER