Healthcare Provider Details

I. General information

NPI: 1063681583
Provider Name (Legal Business Name): PATRICE CALLAHAN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5741 BEE RIDGE RD SUITE 280
SARASOTA FL
34233-5064
US

IV. Provider business mailing address

5741 BEE RIDGE RD SUITE 280
SARASOTA FL
34233-5064
US

V. Phone/Fax

Practice location:
  • Phone: 941-365-0655
  • Fax:
Mailing address:
  • Phone: 941-365-0655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: SEAN O'NEAL
Title or Position: ADMINISTRATOR
Credential:
Phone: 941-365-0655