Healthcare Provider Details

I. General information

NPI: 1528452026
Provider Name (Legal Business Name): BRIAN T CALLIHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 NORTH BLVD STE 200
BATON ROUGE LA
70806-3743
US

IV. Provider business mailing address

3801 NORTH BLVD
BATON ROUGE LA
70806-3825
US

V. Phone/Fax

Practice location:
  • Phone: 225-387-7899
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number303261
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: