Healthcare Provider Details

I. General information

NPI: 1629079504
Provider Name (Legal Business Name): DANIEL G MCALLISTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 06/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 E BARNETT RD DEPT OF PEDIATRICS
MEDFORD OR
97504-8332
US

IV. Provider business mailing address

2620 E BARNETT RD
MEDFORD OR
97504-8344
US

V. Phone/Fax

Practice location:
  • Phone: 541-789-4231
  • Fax: 541-789-5934
Mailing address:
  • Phone: 541-789-4281
  • Fax: 541-789-2558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number10519
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM4333
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD171590
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: