Provider Demographics
NPI:1467680793
Name:CALDWELL, KENNETH LEE (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:LEE
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3636 OLD SPANISH TRL # 341
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-2456
Mailing Address - Country:US
Mailing Address - Phone:713-401-2896
Mailing Address - Fax:713-359-2228
Practice Address - Street 1:3919 WOODLAWN AVE STE B
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1995
Practice Address - Country:US
Practice Address - Phone:281-598-3638
Practice Address - Fax:855-592-2529
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP8866207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146768079303Medicaid
TX1114585395OtherTYPE 2 NPI
TX1114585395OtherTYPE 2-GROUP NPI
TX851963OtherINDIVIDUAL PTAN