Provider Demographics
NPI:1255026159
Name:MCCALLA, WILLIAM III (LAC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:MCCALLA
Suffix:III
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15035 N THOMPSON PEAK PKWY UNIT 105
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2221
Mailing Address - Country:US
Mailing Address - Phone:480-767-1245
Mailing Address - Fax:
Practice Address - Street 1:15035 N THOMPSON PEAK PKWY UNIT 105
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2221
Practice Address - Country:US
Practice Address - Phone:480-767-1245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1089171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist