1760674089 NPI number — ROBERT L CALDWELL MD PLLC

Table of content: (NPI 1760674089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760674089 NPI number — ROBERT L CALDWELL MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT L CALDWELL MD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760674089
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 98886
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98496-8886
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-584-3577
Provider Business Mailing Address Fax Number:
253-584-8916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4905 108TH ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98499-3724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-581-3075
Provider Business Practice Location Address Fax Number:
253-581-3178
Provider Enumeration Date:
08/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CALDWELL
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
253-564-0654

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD00032296 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 130531 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1107945 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com