Provider Demographics
NPI:1245220771
Name:CALCAGNO, JOHN ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANTHONY
Last Name:CALCAGNO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:24850 SE STARK ST
Mailing Address - Street 2:STE 150
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-8318
Mailing Address - Country:US
Mailing Address - Phone:503-491-0714
Mailing Address - Fax:503-674-2834
Practice Address - Street 1:24850 SE STARK ST
Practice Address - Street 2:STE 150
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-8318
Practice Address - Country:US
Practice Address - Phone:503-491-0714
Practice Address - Fax:503-674-2834
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2011-10-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD14823208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR153684Medicaid
OR153684Medicaid