MEDICARE: DR. JOHN THOMAS CALLAHAN D.P.M.

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	DP00297	OR

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
2	067947000	OTHER	OR	BCBS
3	5156300001	OTHER	OR	CIGRA DMERC

General Provider Information

NPI Number	:	1861496804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN THOMAS CALLAHAN D.P.M.

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

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. JOHN THOMAS CALLAHAN D.P.M.” Practice Location

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