Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 1-137962 | AL |
NPI | 1073172805 |
---|---|
Provider Name | Constance Dyas Callen |
First Address | Auburn, AL 36830-7530 |
Second Address | Opelika, AL 36801-5403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2019 |
Last Update Date | 05/06/2019 |