Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | C8109 | AR |
NPI | 1023061850 |
---|---|
Provider Name | Charles R Caldwell JR. |
First Address | Little Rock, AR 72205-6225 |
Second Address | North Little Rock, AR 72117-2929 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 02/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
128458001 | (05) | AR |
G12435 | (02) | AR |