Provider Demographics
NPI:1285361642
Name:CALDWELL, BRIAN
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W TENNESSEE ST STE 5
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32304-3348
Mailing Address - Country:US
Mailing Address - Phone:850-264-7591
Mailing Address - Fax:448-666-1807
Practice Address - Street 1:1800 W TENNESSEE ST STE 5
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304-3348
Practice Address - Country:US
Practice Address - Phone:850-264-7591
Practice Address - Fax:448-666-1807
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL21000063839332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG21000076703OtherPRIVATE PAY/RETAIL