Provider Demographics
NPI:1588413918
Name:CALLAWAY, ANTHONY DWIGHT
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:DWIGHT
Last Name:CALLAWAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 S KINGS VALLEY HWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-9000
Mailing Address - Country:US
Mailing Address - Phone:503-507-1047
Mailing Address - Fax:
Practice Address - Street 1:2540 S KINGS VALLEY HWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-9000
Practice Address - Country:US
Practice Address - Phone:503-507-1047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-17
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator