Provider Demographics
NPI:1750305025
Name:CALLAHAM, PETER R (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:R
Last Name:CALLAHAM
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 1:280 SIERRA COLLEGE DR STE 205
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5763
Mailing Address - Country:US
Mailing Address - Phone:530-273-8452
Mailing Address - Fax:530-477-5182
Practice Address - Street 1:280 SIERRA COLLEGE DR STE 205
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5763
Practice Address - Country:US
Practice Address - Phone:530-273-8452
Practice Address - Fax:530-477-5182
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54736207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G547360Medicaid
CA00G547360Medicare PIN
CA00G547360Medicaid