Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 0101037654 | VA |
N | 207N00000X | Dermatologist | 042351 | GA |
NPI | 1023129905 |
---|---|
Provider Name | Dr. Calvin Odell Mccall JR. |
First Address | Richmond, VA 23249-0001 |
Second Address | Richmond, VA 23249-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 10/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00713358B | (05) | GA |
B10252 | (02) |