Individual
DR. RENATO M CABALLERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3201 W GORE BLVD, STE 301, LAWTON, OK 73505
(580) 248-8225
(580) 248-8919
Mailing address
PO BOX 785, LAWTON, OK 73502
(580) 357-9984
(580) 357-3277
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
14902
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080194100
RAILROAD MEDICARE
—
01
—
100138580B
SOONERCARE CHOICE
OK
05
—
100138580C
—
OK
01
—
125324500
DOL
OK
01
—
404757
AETNA
OK
Enumeration date
09/14/2005
Last updated
01/29/2009
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