Provider Demographics
NPI:1730140898
Name:CALDERWOOD, GREGG W (MD)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:W
Last Name:CALDERWOOD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1223 S GEAR AVE
Mailing Address - Street 2:STE 208
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1682
Mailing Address - Country:US
Mailing Address - Phone:319-752-4541
Mailing Address - Fax:319-752-2972
Practice Address - Street 1:1223 S GEAR AVE
Practice Address - Street 2:STE 208
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1682
Practice Address - Country:US
Practice Address - Phone:319-752-4541
Practice Address - Fax:319-752-2972
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2012-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA22096207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1730140898OtherWELLMARK
IA1730140898Medicaid
IA1730140898OtherWELLMARK
IA1730140898Medicaid