Provider Demographics
NPI:1578817664
Name:CALDWELL, RUAL CLAY JR
Entity Type:Individual
Prefix:MR
First Name:RUAL
Middle Name:CLAY
Last Name:CALDWELL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4560 PAULA DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-7254
Mailing Address - Country:US
Mailing Address - Phone:901-412-6006
Mailing Address - Fax:
Practice Address - Street 1:54 W BROOKS RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38109-7943
Practice Address - Country:US
Practice Address - Phone:901-412-6006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)