Doctor Name: | GAGE MANNING CAUDELL |
NPI Number: | 1013188291 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.P.M. |
License Number: | 36003452 |
Business Practice Address: | 7601 W Jefferson Blvd Fort Wayne, IN - 468044133 |
Business Phone Number: | 2604368686 |
Business Fax Number: | 2604368585 |
Mailing Address: | Po Box 208, FORT WAYNE |
State: | IN |
Postal Code: | 468010208 |
Phone Number: | 2604368686 |
Fax Number: | 2604368585 |
NPI Enumeration Date: | 03/17/2008 |
NPI Last Update Date: | 09/02/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 36003452 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OH |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |