Provider Demographics
NPI:1437129855
Name:CAUDILL, GEORGE H (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:H
Last Name:CAUDILL
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 1:1893 REDFOX ROAD
Mailing Address - Street 2:BOX 98
Mailing Address - City:RED FOX
Mailing Address - State:KY
Mailing Address - Zip Code:41847-0098
Mailing Address - Country:US
Mailing Address - Phone:606-642-3250
Mailing Address - Fax:606-642-3740
Practice Address - Street 1:1893 REDFOX ROAD
Practice Address - Street 2:
Practice Address - City:RED FOX
Practice Address - State:KY
Practice Address - Zip Code:41847-0098
Practice Address - Country:US
Practice Address - Phone:606-642-3250
Practice Address - Fax:606-642-3740
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19066208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64190663Medicaid
KY64190663Medicaid
KY1190001Medicare PIN