Doctor Name: | BRENT K. CAUDILL |
NPI Number: | 1023083722 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 109789 |
Business Practice Address: | Hwy 72 N Salem, MO - 65560 |
Business Phone Number: | 5737296626 |
Business Fax Number: | 5737296502 |
Mailing Address: | Hwy 72 N, Po Box 774 SALEM |
State: | MO |
Postal Code: | 65560 |
Phone Number: | 5737296626 |
Fax Number: | 5737296502 |
NPI Enumeration Date: | 02/17/2006 |
NPI Last Update Date: | 09/15/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 109789 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |