Provider Demographics
NPI:1861496804
Name:CALLAHAN, JOHN THOMAS (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 MISSION ST SE
Mailing Address - Street 2:STE 150
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-1294
Mailing Address - Country:US
Mailing Address - Phone:503-581-2505
Mailing Address - Fax:503-581-2515
Practice Address - Street 1:2235 MISSION ST SE
Practice Address - Street 2:STE 150
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1294
Practice Address - Country:US
Practice Address - Phone:503-581-2505
Practice Address - Fax:503-581-2515
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00297213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR138101Medicaid
OR067947000OtherBCBS
OR5156300001OtherCIGRA DMERC
OR106433Medicare ID - Type Unspecified
OR5156300001OtherCIGRA DMERC