Provider Demographics
NPI:1164040077
Name:CALDERON RODRIGUEZ, ALEX EDUARDO (MD)
Entity type:Individual
Prefix:DR
First Name:ALEX EDUARDO
Middle Name:
Last Name:CALDERON RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7303 ROGERS AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-4112
Mailing Address - Country:US
Mailing Address - Phone:479-274-4300
Mailing Address - Fax:479-274-4399
Practice Address - Street 1:7303 ROGERS AVE STE 200
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4112
Practice Address - Country:US
Practice Address - Phone:479-274-4300
Practice Address - Fax:479-274-4399
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2025-06-27
Deactivation Date:2022-01-19
Deactivation Code:
Reactivation Date:2022-03-30
Provider Licenses
StateLicense IDTaxonomies
ARE-19012207RN0300X
MO2020018997390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology