Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 7977 | AZ |
N | 207QA0505X | Family Doctor - Adult Medicine | 7977 | AZ |
N | 208000000X | Pediatrician | 7977 | AZ |
NPI | 1346255221 |
---|---|
Provider Name | Dr. Henry H Kaldenbaugh |
First Address | Cottonwood, AZ 86326-3907 |
Second Address | Cottonwood, AZ 86326-3907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2006 |
Last Update Date | 18/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
203828001 | (05) | AZ |
C99719 | (02) | AZ |