Provider Demographics
NPI:1558342204
Name:CALLO, GUILLERMO (MD)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:
Last Name:CALLO
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 4994
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79704-4994
Mailing Address - Country:US
Mailing Address - Phone:432-570-6655
Mailing Address - Fax:
Practice Address - Street 1:2407 W LOUISIANA AVE
Practice Address - Street 2:SUITE 103B
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5807
Practice Address - Country:US
Practice Address - Phone:432-570-6655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2186207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033016901Medicaid
109761100OtherFIRST CARE
TX00EP16OtherBLUE CROSS BLUE SHIELD
C14094Medicare UPIN
TX033016901Medicaid
TX00EP16Medicare PIN