Provider Demographics
NPI:1750387098
Name:CALDWELL, C. EDWARD (DPM)
Entity type:Individual
Prefix:DR
First Name:C. EDWARD
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1448
Mailing Address - Street 2:
Mailing Address - City:LAURIE
Mailing Address - State:MO
Mailing Address - Zip Code:65038-1448
Mailing Address - Country:US
Mailing Address - Phone:573-374-2200
Mailing Address - Fax:
Practice Address - Street 1:138 S MAIN ST
Practice Address - Street 2:STE A
Practice Address - City:LAURIE
Practice Address - State:MO
Practice Address - Zip Code:65037-6196
Practice Address - Country:US
Practice Address - Phone:573-374-2200
Practice Address - Fax:573-374-7441
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000789213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU71301Medicare UPIN