Provider Demographics
NPI:1811960628
Name:CARGILL, CALVIN L (MD)
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:L
Last Name:CARGILL
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:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:TX
Mailing Address - Zip Code:79782-0640
Mailing Address - Country:US
Mailing Address - Phone:432-607-3243
Mailing Address - Fax:432-607-3629
Practice Address - Street 1:600 E I20
Practice Address - Street 2:SUITE 104
Practice Address - City:STANTON
Practice Address - State:TX
Practice Address - Zip Code:79782
Practice Address - Country:US
Practice Address - Phone:432-607-3243
Practice Address - Fax:432-607-3629
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133360108Medicaid
TX141841001OtherEPSDT
TX4366536OtherAETNA
TXTIN PLUS SUFFIX 043OtherTRICARE
TX127408OtherCHIPS
TX752616977066OtherTRICARE
TXTIN PLUS SUFFIX 001OtherTRICARE
TXTIN PLUS SUFFIX 043OtherTRICARE
TXTIN PLUS SUFFIX 001OtherTRICARE
TX8C9094Medicare Oscar/Certification