Provider Demographics
NPI:1255389854
Name:CALDERON, JOSE WILFRIDO (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:WILFRIDO
Last Name:CALDERON
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 1:727 S. GARFIELD AVE
Mailing Address - Street 2:P.O. BOX 752
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-0752
Mailing Address - Country:US
Mailing Address - Phone:319-753-2491
Mailing Address - Fax:319-753-2491
Practice Address - Street 1:1221 S GEAR AVE
Practice Address - Street 2:
Practice Address - City:W BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1679
Practice Address - Country:US
Practice Address - Phone:319-753-2491
Practice Address - Fax:319-753-2491
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2007207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA28509OtherBLUE CROSS-BLUE SHIELD
IA0285098Medicaid
IAE07347Medicare UPIN
IA0285098Medicaid