1881795383 NPI number — DR. ROBERT GIPSON CALLAHAN MD

Table of content: DR. ROBERT GIPSON CALLAHAN MD (NPI 1881795383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881795383 NPI number — DR. ROBERT GIPSON CALLAHAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALLAHAN
Provider First Name:
ROBERT
Provider Middle Name:
GIPSON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CALLAHAN
Provider Other First Name:
ROBERT
Provider Other Middle Name:
G
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PMC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1881795383
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 168
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARTHAGE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75633-0168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-694-4935
Provider Business Mailing Address Fax Number:
903-694-4858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 COTTAGE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARTHAGE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75633-0168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-694-4935
Provider Business Practice Location Address Fax Number:
903-694-4677
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  K8046 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 029565101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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