Provider Demographics
NPI:1144363540
Name:ROBERT CALDWELL DPM PC
Entity type:Organization
Organization Name:ROBERT CALDWELL DPM PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:E
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:319-363-3543
Mailing Address - Street 1:1700 1ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5433
Mailing Address - Country:US
Mailing Address - Phone:319-363-3543
Mailing Address - Fax:319-366-4567
Practice Address - Street 1:1700 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5433
Practice Address - Country:US
Practice Address - Phone:319-363-3543
Practice Address - Fax:319-366-4567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1069270001332B00000X
IA213ES0103X213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1069270001Medicare NSC
IAI9369Medicare ID - Type Unspecified