Provider Demographics
NPI:1518997188
Name:MCCALLUM, JEFFREY BORDEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BORDEN
Last Name:MCCALLUM
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 1:302 MEDICAL PARK CT
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4346
Mailing Address - Country:US
Mailing Address - Phone:252-247-2013
Mailing Address - Fax:252-247-7299
Practice Address - Street 1:302 MEDICAL PARK CT
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4346
Practice Address - Country:US
Practice Address - Phone:252-247-2013
Practice Address - Fax:252-247-7299
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054871207R00000X
NC2005-01961207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA752086094AMedicaid
I34126Medicare UPIN
GA752086094AMedicaid