Provider Demographics
NPI:1568464634
Name:CALDWELL, MAUREEN LEIGH (DPM)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:LEIGH
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 IMPERIAL DR
Mailing Address - Street 2:STE A
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-3948
Mailing Address - Country:US
Mailing Address - Phone:361-578-2777
Mailing Address - Fax:361-578-2778
Practice Address - Street 1:116 IMPERIAL DR
Practice Address - Street 2:STE A
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-3948
Practice Address - Country:US
Practice Address - Phone:361-578-2777
Practice Address - Fax:361-578-2778
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1357213E00000X, 213ES0103X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84530NOtherBCBS PROVIDER NUMBER
TX092736002Medicaid
TXP00143475OtherRAILROAD MEDICARE
TX84530NMedicare PIN
TX84530NOtherBCBS PROVIDER NUMBER