Provider Demographics
NPI:1255828166
Name:CALLAHAN, EDWARD JAMES III (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:JAMES
Last Name:CALLAHAN
Suffix:III
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10281 BENTLEY OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2037
Mailing Address - Country:US
Mailing Address - Phone:509-679-2668
Mailing Address - Fax:
Practice Address - Street 1:3425 BAYSIDE LAKES BLVD SE # 10310114
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-6867
Practice Address - Country:US
Practice Address - Phone:385-229-9889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME171043208D00000X
UT11427675-12052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology