Provider Demographics
NPI:1679673420
Name:CALDWELL, JUDY L (DO)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:L
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 S MALL DR STE 213
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4944
Mailing Address - Country:US
Mailing Address - Phone:435-703-9499
Mailing Address - Fax:435-477-6990
Practice Address - Street 1:446 S MALL DR STE 213
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4944
Practice Address - Country:US
Practice Address - Phone:435-703-9499
Practice Address - Fax:435-477-6990
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6927207Q00000X
NVDO1441207Q00000X
UT9897237-1204207QG0300X, 207QH0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH44176Medicare UPIN