Individual
ALBERT G CACCAVALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1003 WILLOW CREEK RD, PRESCOTT, AZ 86301-1641
(928) 771-5420
(928) 771-5471
Mailing address
PO BOX 11720, PRESCOTT, AZ 86304-1720
(928) 771-5487
(928) 771-5471
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
1944
AZ
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
47673
CO
208M00000X
Hospitalist Physician
Primary
1944
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
109745
AHCCCS
—
01
—
109745004
APIPA
—
05
—
29826551
—
CO
05
—
913113200
—
FL
01
—
AZ0744400
BCBS
—
Enumeration date
09/27/2005
Last updated
02/22/2018
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