Provider Demographics
NPI:1982682209
Name:CALDWELL, DOUGLAS PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:PAUL
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7595 ANAGRAM DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7399
Mailing Address - Country:US
Mailing Address - Phone:612-573-2200
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:7595 ANAGRAM DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7399
Practice Address - Country:US
Practice Address - Phone:612-573-2200
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000424092085R0202X
ID123482085R0202X
MN648272085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1982682209Medicaid
WA172345OtherL&I PROVIDER NUMBER
WA8361081Medicaid
WA184435OtherL&I PROVIDER NUMBER
WA172074OtherL&I PROVIDER NUMBER
WAG8879291Medicare PIN
WAH66262Medicare UPIN
WA184435OtherL&I PROVIDER NUMBER
WAP00039187Medicare PIN
ID20005742Medicare PIN
WA172074OtherL&I PROVIDER NUMBER
WAGAB37658Medicare PIN
WAG8802527Medicare PIN
WAG8863813Medicare PIN
WAGAB37657Medicare PIN
WAP00368453Medicare PIN
WA8361081Medicaid