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General NPI Number Information
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NPI Number | 1962765222
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Entity Type | Individual
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Provider Name | RYAN CALLAHAN D.O
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Gender | Male
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 1218 9TH ST STE 10
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City | RUPERT
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State | ID
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Zip | 83350-2207
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Country | US
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Telephone | 208-436-8340
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Fax | 208-436-9760
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Provider Business Mailing Address
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Address Line | 2655 NW HIGHLAND DR UNIT 32
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City | CORVALLIS
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State | OR
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Zip | 97330-3692
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Country | US
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Telephone | 515-422-4786
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 14175036-1204
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number | O-1152
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | PG158100
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License Number State | OR
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