| Caldwell General Practice, Inc. | |
|
2880 Netherton Dr Suite 103 St. Louis MO 63136 | |
| (314) 521-7768 | |
| (314) 838-3683 |
| Full Name | Caldwell General Practice, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 2880 Netherton Dr, St. Louis, Missouri |
| Authorized Official Name and Position | Reynal Leon Caldwell (CEO PHYSICIAN) |
| Authorized Official Contact | 3145217768 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Caldwell General Practice, Inc. 2880 Netherton Dr Suite 103 St. Louis MO 63136 Ph: (314) 521-7768 | Caldwell General Practice, Inc. 2880 Netherton Dr Suite 103 St. Louis MO 63136 Ph: (314) 521-7768 |
| NPI Number | 1467450023 |
|---|---|
| Provider Enumeration Date | 07/08/2005 |
| Last Update Date | 05/03/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467450023 | NPI | - | NPPES |
| 242386712 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | R5E11 (Missouri) | Primary |
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