Provider Demographics
NPI:1346283991
Name:CALDWELL, RICHARD B (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:700 IRONWOOD DR
Mailing Address - Street 2:SUITE 272E
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814
Mailing Address - Country:US
Mailing Address - Phone:208-292-0990
Mailing Address - Fax:208-292-2950
Practice Address - Street 1:700 IRONWOOD DR
Practice Address - Street 2:SUITE 170E
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-667-9110
Practice Address - Fax:208-676-1272
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2012-05-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDM3213207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002609500Medicaid
ID1109471Medicare ID - Type Unspecified
IDC36816Medicare UPIN
ID11094701Medicare PIN