Individual
CHARLES M CALDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1020 W FERTITTA BLVD, LEESVILLE, LA 71446-4649
(337) 239-9041
(337) 239-5360
Mailing address
PO BOX 4328, SHREVEPORT, LA 71134-0328
(318) 222-1149
(318) 425-2335
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
MD.15763R
LA
2085R0202X
Diagnostic Radiology Physician
Primary
MD.15763R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1722669
—
LA
Enumeration date
06/07/2006
Last updated
03/25/2011
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