MEDICARE: JOHN T. CALLAHAN, DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	DP000297	OR

General Provider Information

NPI Number	:	1114199361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN T. CALLAHAN, DPM

Provider Business Mailing Address
First Line	:	2235 MISSION ST SE STE 150
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-1294
Country	:	US
Telephone Number	:	503-581-2505
Fax Number	:	503-581-2515

Provider Business Practice Location Address
First Line	:	2235 MISSION ST SE STE 150
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-1294
Country	:	US
Telephone Number	:	503-581-2505
Fax Number	:	503-581-2515

Authorized Official
Title or Position	:	PODIATRIC PHYSICIAN AND SURGEON
Name	:	DR. JOHN THOMAS CALLAHAN
Credential	:	DPM
Telephone Number	:	503-581-2505

Provider Enumeration Date	:	03/27/2008
Last Update Date	:	06/16/2008

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