Provider Demographics
NPI:1831291723
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 1:1814 ROSELAND BLVD
Practice Address - Street 2:#200
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-4234
Practice Address - Country:US
Practice Address - Phone:903-531-2500
Practice Address - Fax:903-595-3785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0021KVOtherBLUE CROSS BLUE SHIELD
TX170067601Medicaid
0021KVOtherBLUE CROSS BLUE SHIELD
TX6261080001Medicare NSC