Provider Demographics
NPI:1629246202
Name:CALLAHAN, RANDY JAMES (PA)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:JAMES
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:1322 E SHAW AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7904
Mailing Address - Country:US
Mailing Address - Phone:559-226-1316
Mailing Address - Fax:559-226-1315
Practice Address - Street 1:1322 E SHAW AVE STE 410
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7904
Practice Address - Country:US
Practice Address - Phone:559-226-1316
Practice Address - Fax:559-226-1615
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2020-10-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA12968363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant