Basic Information
| Provider Information | |||||||||
| NPI: | 1639361447 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CALDER | ||||||||
| FirstName: | KENNETH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14275 MIDWAY RD | ||||||||
| Address2: | STE 400 | ||||||||
| City: | ADDISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750013676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003306565 | ||||||||
| FaxNumber: | 5617127349 | ||||||||
| Practice Location | |||||||||
| Address1: | 10500 UNIVERSITY CENTER DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336126494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009296694 | ||||||||
| FaxNumber: | 8139716675 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2007 | ||||||||
| LastUpdateDate: | 09/26/2016 | ||||||||
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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 | 390200000X | TRN8901 | FL | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207ZD0900X | ME108309 | FL | Y | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology |
No ID Information.