Provider Demographics
NPI:1023096427
Name:CALLAHAN, SCOT C (MD)
Entity type:Individual
Prefix:
First Name:SCOT
Middle Name:C
Last Name:CALLAHAN
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:PO BOX 311464
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36331
Mailing Address - Country:US
Mailing Address - Phone:334-393-6673
Mailing Address - Fax:334-347-9599
Practice Address - Street 1:101 E BRUNSON ST
Practice Address - Street 2:STE 100
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330
Practice Address - Country:US
Practice Address - Phone:334-393-6673
Practice Address - Fax:334-347-9599
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2019-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18006207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
77626OtherBCBS
AL77626Medicaid
F82441Medicare UPIN