Basic Information
| Provider Information | |||||||||
| NPI: | 1053395715 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALDWELL | ||||||||
| FirstName: | DYLAN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1250 PINE RIDGE ROAD | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2395667676 | ||||||||
| FaxNumber: | 2395669149 | ||||||||
| Practice Location | |||||||||
| Address1: | 1250 PINE RIDGE ROAD | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2395667676 | ||||||||
| FaxNumber: | 2395669149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2005 | ||||||||
| LastUpdateDate: | 09/20/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | ME80596 | FL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 261410300 | 05 | FL | MEDICAID | 58881 | 01 | FL | BCBS | OTHER |