Provider Demographics
NPI:1629398268
Name:CALDWELL, CHARLES BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:BRIAN
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 1:110 MEDICAL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71852-8606
Mailing Address - Country:US
Mailing Address - Phone:870-845-6060
Mailing Address - Fax:870-845-6058
Practice Address - Street 1:110 MEDICAL CIRCLE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852-8606
Practice Address - Country:US
Practice Address - Phone:870-845-6060
Practice Address - Fax:870-845-6058
Is Sole Proprietor?:No
Enumeration Date:2010-06-06
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-7128207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR417908ZPJEMedicare UPIN