MEDICARE: EDWARD JAMES CALLAHAN III MD

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	208D00000X	General Practice Physician	ME171043	FL
2	2085R0202X	Diagnostic Radiology Physician	11427675-1205	UT

General Provider Information

NPI Number	:	1255828166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD JAMES CALLAHAN III MD

Provider Business Mailing Address
First Line	:	10281 BENTLEY OAKS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-2037
Country	:	US
Telephone Number	:	385-229-9889
Fax Number	:

Provider Business Practice Location Address
First Line	:	3425 BAYSIDE LAKES BLVD SE # 10310114
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-6867
Country	:	US
Telephone Number	:	385-229-9889
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2018
Last Update Date	:	07/25/2025

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