Provider Demographics
NPI:1447667332
Name:CALDER, JAMES OTTO (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:OTTO
Last Name:CALDER
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 1:1210 KY HIGHWAY 36 E STE 2A
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-7492
Mailing Address - Country:US
Mailing Address - Phone:859-298-2650
Mailing Address - Fax:859-234-0530
Practice Address - Street 1:1210 KY HIGHWAY 36 E STE 2A
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-7492
Practice Address - Country:US
Practice Address - Phone:859-298-2650
Practice Address - Fax:859-234-0530
Is Sole Proprietor?:No
Enumeration Date:2014-07-13
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY51433207RA0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100370170Medicaid