MEDICARE: RICHARD CHARLES CALLISON JR. 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	2085R0204X	Vascular & Interventional Radiology Physician	ME141454	FL
2	2085R0204X	Vascular & Interventional Radiology Physician	2010011553	MO
3	2084V0102X	Vascular Neurology Physician	37238	IA
4	2084N0400X	Neurology Physician	2003025920	MO
5	2084V0102X	Vascular Neurology Physician	2010011553	MO
6	2084V0102X	Vascular Neurology Physician	ME141454	FL
7	2084N0400X	Neurology Physician	37238	IA
8	2084N0400X	Neurology Physician	2010011553	MO
9	2085R0204X	Vascular & Interventional Radiology Physician	37238	IA
10	2084N0400X	Neurology Physician	ME141454	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326253832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD CHARLES CALLISON JR. MD

Provider Business Mailing Address
First Line	:	2402 FRIST BLVD STE 201
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4838
Country	:	US
Telephone Number	:	772-460-8838
Fax Number	:	772-460-8808

Provider Business Practice Location Address
First Line	:	2402 FRIST BLVD STE 201
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4838
Country	:	US
Telephone Number	:	772-460-8838
Fax Number	:	772-460-8808

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

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	03/03/2026

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Directions to “ RICHARD CHARLES CALLISON JR. MD” Practice Location

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