Provider Demographics
NPI:1629182332
Name:CALDWELL, RICHARD K (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:K
Last Name:CALDWELL
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:PO BOX 1569
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35902-1569
Mailing Address - Country:US
Mailing Address - Phone:256-543-9302
Mailing Address - Fax:256-547-4539
Practice Address - Street 1:417B S 4TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5214
Practice Address - Country:US
Practice Address - Phone:256-543-9302
Practice Address - Fax:256-547-6869
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19865207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000036831Medicaid
AL051075525OtherBLUECROSS BLUESHIELD
AL051036831OtherBLUECROSS BLUESHIELD
000036831Medicare ID - Type Unspecified
G26995Medicare UPIN
040010771Medicare ID - Type UnspecifiedRAILROAD MEDICARE
AL051036831OtherBLUECROSS BLUESHIELD