Provider Demographics
NPI:1780663575
Name:CALDWELL, KAMMIE MARIE (MD)
Entity Type:Individual
Prefix:MRS
First Name:KAMMIE
Middle Name:MARIE
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1202 W CHEROKEE ST STE D
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-4629
Mailing Address - Country:US
Mailing Address - Phone:918-485-2104
Mailing Address - Fax:888-815-0475
Practice Address - Street 1:2109 S HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-9310
Practice Address - Country:US
Practice Address - Phone:918-485-6069
Practice Address - Fax:888-815-0475
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK24211207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200049030BMedicaid
OK466873YMQ7Medicare PIN
OK200049030BMedicaid
OK200049030BMedicaid