Provider Demographics
NPI:1760526222
Name:CALLANAN, DAVID A (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:CALLANAN
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 1:1744 E MCANDREWS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504
Mailing Address - Country:US
Mailing Address - Phone:541-776-0821
Mailing Address - Fax:541-776-5011
Practice Address - Street 1:1744 E MCANDREWS RD
Practice Address - Street 2:SUITE B
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-776-0821
Practice Address - Fax:541-776-5011
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD 181182084P0804X
ORMD181182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORMD 18118OtherMD LICENSE NUMBER
ORBC 2189202OtherDEA NUMBER
ORMD 18118OtherMD LICENSE NUMBER