Provider Demographics
NPI:1942406616
Name:CALLENDER, MARK D (PA)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:D
Last Name:CALLENDER
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Gender:M
Credentials:PA
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Mailing Address - Street 1:2104 GAUSE BLVD W
Mailing Address - Street 2:STE. A
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-4130
Mailing Address - Country:US
Mailing Address - Phone:985-643-4575
Mailing Address - Fax:985-643-4513
Practice Address - Street 1:2104 GAUSE BLVD W
Practice Address - Street 2:STE. A
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70460-4130
Practice Address - Country:US
Practice Address - Phone:985-643-4575
Practice Address - Fax:985-643-4513
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2015-10-15
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Provider Licenses
StateLicense IDTaxonomies
LAP.A.A10540363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant