Provider Demographics
NPI:1508809138
Name:CALLAHAN, THOMAS E III (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:CALLAHAN
Suffix:III
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 1:4005 24TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1815
Mailing Address - Country:US
Mailing Address - Phone:806-792-2767
Mailing Address - Fax:
Practice Address - Street 1:4005 24TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1835
Practice Address - Country:US
Practice Address - Phone:806-792-2767
Practice Address - Fax:806-791-6709
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM78902085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2107619Medicaid
P00602905OtherRAILROAD MEDICARE
MAJ28704OtherBLUE CROSS BLUE SHIELD
MAAA64569OtherHARVARD PILGRIM HEALTHCAR
MA462205OtherTUFTS
MAJ28704OtherBLUE CROSS BLUE SHIELD
MA2107619Medicaid