Provider Demographics
NPI:1710522156
Name:CALDWELL, CLIFFORD II
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:
Last Name:CALDWELL
Suffix:II
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 1:803 ORION DR
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-3473
Mailing Address - Country:US
Mailing Address - Phone:318-884-8051
Mailing Address - Fax:
Practice Address - Street 1:803 ORION DR
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-3473
Practice Address - Country:US
Practice Address - Phone:318-884-8051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010585243343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)