Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 18006 | AL |
NPI | 1023096427 |
---|---|
Provider Name | Scot C Callahan |
First Address | Enterprise, AL 36331 |
Second Address | Enterprise, AL 36330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2006 |
Last Update Date | 27/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
77626 | (05) | AL |
77626 | BCBS (01) | |
F82441 | (02) |