Provider Demographics
NPI:1255751186
Name:CALLAWAY, EILEEN CLAIRE (MD)
Entity type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:CLAIRE
Last Name:CALLAWAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10491 6 MILE CYPRESS PKWY STE 271
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-6518
Mailing Address - Country:US
Mailing Address - Phone:239-215-3500
Mailing Address - Fax:239-215-3525
Practice Address - Street 1:10491 6 MILE CYPRESS PKWY STE 271
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-6518
Practice Address - Country:US
Practice Address - Phone:239-215-3500
Practice Address - Fax:239-215-3525
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME131337207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPNF4KOtherFLORIDA BLUE - BCBS
FLXGZN9OtherFLORIDA BLUE - BCBS
FL105682700Medicaid
FL114316000Medicaid