Provider Demographics
NPI:1689758120
Name:MCCALLUM, DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
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 1:46 SGT PRENTISS DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4792
Mailing Address - Country:US
Mailing Address - Phone:601-442-9654
Mailing Address - Fax:601-442-0013
Practice Address - Street 1:46 SGT PRENTISS DR
Practice Address - Street 2:SUITE 103
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4792
Practice Address - Country:US
Practice Address - Phone:601-442-9654
Practice Address - Fax:601-442-0013
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3870207X00000X
MS21591207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD3870Medicaid
AKMD3870Medicaid
AKK150201Medicare PIN