Provider Demographics
NPI:1881795383
Name:CALLAHAN, ROBERT GIPSON (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GIPSON
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:G
Other - Last Name:CALLAHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMC
Mailing Address - Street 1:PO BOX 168
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75633-0168
Mailing Address - Country:US
Mailing Address - Phone:903-694-4935
Mailing Address - Fax:903-694-4858
Practice Address - Street 1:307 COTTAGE ROAD
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TX
Practice Address - Zip Code:75633-0168
Practice Address - Country:US
Practice Address - Phone:903-694-4935
Practice Address - Fax:903-694-4677
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8046208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029565101Medicaid
TX00095MMedicare PIN