Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | MD19523 | OR |
NPI | 1154548881 |
---|---|
Provider Name | Dr. Leta Teresa Callahan |
First Address | Wheeler, OR 97147 |
Second Address | Wheeler, OR 97147 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 22/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1154548881 | (05) | OR |
F09513 | (02) |