Provider Demographics
NPI:1457390619
Name:O'CALLAGHAN, WILLIAM G (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:G
Last Name:O'CALLAGHAN
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 1:7829 E SAN CARLOS RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3410
Mailing Address - Country:US
Mailing Address - Phone:956-778-3426
Mailing Address - Fax:
Practice Address - Street 1:7829 E SAN CARLOS RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3410
Practice Address - Country:US
Practice Address - Phone:956-682-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17492207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150504203Medicaid
TX361666YUQGMedicare PIN
TX8073B4Medicare PIN
TX8A4741OtherBLUE CROSS/SHIELD
TX148060001Medicaid