Provider Demographics
NPI:1003894999
Name:MCCALLIE, BRIAN JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JAMES
Last Name:MCCALLIE
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 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1501
Practice Address - Street 1:19020 33RD AVE W STE 210
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4748
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1501
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000401072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA192386OtherL&I PROVIDER NUMBER
WA192384OtherL&I PROVIDER NUMBER
WA8279937Medicaid
WA192385OtherL&I PROVIDER NUMBER
WA192386OtherL&I PROVIDER NUMBER
WAG8872046Medicare PIN
P00368478OtherRR MEDICARE
WA192384OtherL&I PROVIDER NUMBER
WAG8850563Medicare PIN
WAH14746Medicare UPIN
WAG8850564Medicare PIN
P00185166Medicare PIN
WA192386OtherL&I PROVIDER NUMBER
P00305316Medicare PIN
WAG8850830Medicare PIN