Provider Demographics
NPI:1568649812
Name:CALDERON, ROBERTO DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:DANIEL
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 1:3811 E BELL RD STE 309
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2160
Mailing Address - Country:US
Mailing Address - Phone:480-420-0749
Mailing Address - Fax:480-420-0732
Practice Address - Street 1:3811 E BELL RD STE 309
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032
Practice Address - Country:US
Practice Address - Phone:480-420-0749
Practice Address - Fax:480-420-0732
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-00002207X00000X
MT21200207X00000X
AZ34221207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00817167OtherMEDICARE RR
MDP00884670OtherRR MEDICARE
NCNCB434AOtherMEDICARE PTAN
MD183805ZAQBMedicare PIN