Provider Demographics
NPI:1225065246
Name:MCCALL, ANDREW L (DPM PA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:L
Last Name:MCCALL
Suffix:
Gender:M
Credentials:DPM PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 CORTEZ AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7554
Mailing Address - Country:US
Mailing Address - Phone:208-529-0229
Mailing Address - Fax:888-688-3439
Practice Address - Street 1:2920 CORTEZ AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7554
Practice Address - Country:US
Practice Address - Phone:208-529-0229
Practice Address - Fax:888-688-3439
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP190213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDM8073084Medicaid
ID1368464Medicare PIN
IDM8073084Medicaid