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Contact Information

MARTY CAUDLE, PA
404 DURLEY ST
GREENVILLE, IL62246
 Phone: 618-690-3595
 Fax: 618-690-3596
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for MARTY CAUDLE · (Male)

NPI # 1639318645
Status Active
Credentials PA (Physician Assistant)
Entity Individual
Enumeration date 02/13/2009
Last updated 01/05/2024 - About 2 years ago
Sole proprietor 1 No
Identifiers
  • OR License # PA01451
  • TN License # 4854
Hospital affiliation(s)
  • LEGACY MERIDIAN PARK MEDICAL CENTER - (Acute Care)
    19300 SW 65TH AVENUE
    TUALATIN, OR 97062
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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