Provider Demographics
NPI:1164485991
Name:CALLAHAN, STEVEN ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ROBERT
Last Name:CALLAHAN
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:PO BOX 720300
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73172-0300
Mailing Address - Country:US
Mailing Address - Phone:800-749-4560
Mailing Address - Fax:405-751-3183
Practice Address - Street 1:1 HOAG DR
Practice Address - Street 2:ECU DEPT.
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4162
Practice Address - Country:US
Practice Address - Phone:949-764-5689
Practice Address - Fax:405-751-3183
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41150207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G411500Medicaid
CAOOG411500670Medicaid
CA00G411500OtherBLUE SHIELD
CAP002939238OtherRR MEDICARE
CA00G411500OtherBLUE SHIELD
CAWG41150JMedicare PIN