Provider Demographics
NPI:1972508513
Name:CALDERON, VINCENT (MD)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:CALDERON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10301 KANIS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6205
Mailing Address - Country:US
Mailing Address - Phone:501-224-1690
Mailing Address - Fax:501-224-1927
Practice Address - Street 1:10301 KANIS RD STE 1
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6205
Practice Address - Country:US
Practice Address - Phone:501-562-4838
Practice Address - Fax:501-562-1958
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC8179208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR11185OtherQUALCHOICE OF ARKANSAS
AR5J058OtherBLUE CROSS BLUE SHIELD
AR123526001Medicaid
AR1220028OtherUNITED HEALTH CARE NUMBER
AR1220028OtherUNITED HEALTH CARE NUMBER
AR5J058OtherBLUE CROSS BLUE SHIELD