MEDICARE: CALLON DOC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1366162042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALLON DOC

Provider Business Mailing Address
First Line	:	2916 INWOOD RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-7518
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2916 INWOOD RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-7518
Country	:	US
Telephone Number	:	214-466-6618
Fax Number	:	469-666-9422

Authorized Official
Title or Position	:	CEO
Name	:	ADETUNJI OSHUN
Credential	:	PA
Telephone Number	:	214-466-6618

Provider Enumeration Date	:	09/01/2022
Last Update Date	:	09/01/2022

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Directions to “CALLON DOC ” Practice Location

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