Provider Demographics
NPI:1982706339
Name:CALDWELL, JOSEPH GRIMES (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:GRIMES
Last Name:CALDWELL
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 1:12479 STATE ROUTE 104
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43103-9643
Mailing Address - Country:US
Mailing Address - Phone:740-983-8605
Mailing Address - Fax:
Practice Address - Street 1:12479 STATE ROUTE 104
Practice Address - Street 2:
Practice Address - City:ASHVILLE
Practice Address - State:OH
Practice Address - Zip Code:43103-9643
Practice Address - Country:US
Practice Address - Phone:740-983-8605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35027425174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC69624Medicare UPIN