Healthcare Provider Details

I. General information

NPI: 1396858718
Provider Name (Legal Business Name): WILLIAM G CALLAHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33501 1ST WAY S
FEDERAL WAY WA
98003-6208
US

IV. Provider business mailing address

33501 1ST WAY S
FEDERAL WAY WA
98003-6208
US

V. Phone/Fax

Practice location:
  • Phone: 253-874-1668
  • Fax:
Mailing address:
  • Phone: 253-874-1668
  • Fax: 253-874-1749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA100584
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD60027229
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: