Provider Demographics
NPI:1215470588
Name:CALDWELL, DAVID G (CPO, LPO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:CPO, LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-7305
Mailing Address - Country:US
Mailing Address - Phone:972-548-7707
Mailing Address - Fax:972-548-7739
Practice Address - Street 1:330 INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-7305
Practice Address - Country:US
Practice Address - Phone:972-548-7707
Practice Address - Fax:972-548-7739
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101561335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5905440001Medicare PIN