Provider Demographics
NPI:1639437890
Name:AARON K CALODNEY M.D., P.A.
Entity Type:Organization
Organization Name:AARON K CALODNEY M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:K
Authorized Official - Last Name:CALODNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-531-2500
Mailing Address - Street 1:PO BOX 130459
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75713-0459
Mailing Address - Country:US
Mailing Address - Phone:903-531-2500
Mailing Address - Fax:903-595-3785
Practice Address - Street 1:10 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3173
Practice Address - Country:US
Practice Address - Phone:936-631-6000
Practice Address - Fax:936-631-6082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170067601Medicaid