Provider Demographics
NPI:1467637819
Name:CALDERON, PAULO (MD)
Entity Type:Individual
Prefix:
First Name:PAULO
Middle Name:
Last Name:CALDERON
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 1:7501 LAKEVIEW PKWY
Mailing Address - Street 2:SUITE #130
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-9322
Mailing Address - Country:US
Mailing Address - Phone:972-463-3100
Mailing Address - Fax:
Practice Address - Street 1:7501 LAKEVIEW PKWY
Practice Address - Street 2:SUITE #130
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-9322
Practice Address - Country:US
Practice Address - Phone:972-463-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ80882390200000X
TXM9898207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program