Provider Demographics
NPI:1124814223
Name:CALLAHANMD
Entity type:Organization
Organization Name:CALLAHANMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:385-229-9889
Mailing Address - Street 1:10281 BENTLEY OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2037
Mailing Address - Country:US
Mailing Address - Phone:509-679-2668
Mailing Address - Fax:
Practice Address - Street 1:3425 BAYSIDE LAKES BLVD SE # 10310114
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-6867
Practice Address - Country:US
Practice Address - Phone:385-229-9889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty