Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 9002 | TX |
N | 225400000X | Rehabilitation Practitioner | 3772 | AZ |
NPI | 1265457758 |
---|---|
Provider Name | Dr. Lawrence Elton Caudell JR. |
First Address | Houston, TX 77008-3914 |
Second Address | Conroe, TX 77384-8002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 17/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V02741 | (02) | TX |