Provider Demographics
NPI:1881603090
Name:CABALLERO, JOSE R (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:R
Last Name:CABALLERO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:901 LEIGHTON AVE
Mailing Address - Street 2:SUITE 703
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5700
Mailing Address - Country:US
Mailing Address - Phone:256-236-4845
Mailing Address - Fax:256-236-5274
Practice Address - Street 1:901 LEIGHTON AVE
Practice Address - Street 2:SUITE 703
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5700
Practice Address - Country:US
Practice Address - Phone:256-236-4845
Practice Address - Fax:256-236-5274
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2009-02-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL10533208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000087783Medicaid
AL000087783Medicaid