Provider Demographics
NPI:1699730713
Name:CALDWELL, GEORGE L (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:L
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 W CYPRESS CREEK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1866
Mailing Address - Country:US
Mailing Address - Phone:954-358-9474
Mailing Address - Fax:954-686-2687
Practice Address - Street 1:2122 W CYPRESS CREEK RD STE 200
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1866
Practice Address - Country:US
Practice Address - Phone:954-358-9474
Practice Address - Fax:954-686-2687
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66694207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376305600Medicaid
F88591Medicare UPIN
FL376305600Medicaid