Provider Demographics
NPI:1639229198
Name:CALLERY, EARL MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:MICHAEL
Last Name:CALLERY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9245 S MINGO RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5793
Mailing Address - Country:US
Mailing Address - Phone:918-574-0250
Mailing Address - Fax:918-574-0259
Practice Address - Street 1:9245 S MINGO RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5793
Practice Address - Country:US
Practice Address - Phone:918-574-0250
Practice Address - Fax:918-574-0259
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1865207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100255830AMedicaid
E45391Medicare UPIN
OK296813YLV0Medicare PIN