Provider Demographics
NPI:1023061850
Name:CALDWELL, CHARLES R JR (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:CALDWELL
Suffix:JR
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 1:9501 BAPTIST HEALTH DR
Mailing Address - Street 2:SUITE 600 MEDICAL TOWERS II
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6225
Mailing Address - Country:US
Mailing Address - Phone:501-227-7596
Mailing Address - Fax:
Practice Address - Street 1:3343 SPRINGHILL DR
Practice Address - Street 2:SUITE 1035
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2929
Practice Address - Country:US
Practice Address - Phone:501-975-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC8109207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128458001Medicaid
AR5J847Medicare PIN
AR128458001Medicaid