Provider Demographics
NPI:1366162042
Name:CALLON DOC
Entity type:Organization
Organization Name:CALLON DOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADETUNJI
Authorized Official - Middle Name:
Authorized Official - Last Name:OSHUN
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:214-466-6618
Mailing Address - Street 1:2916 INWOOD RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-7518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2916 INWOOD RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7518
Practice Address - Country:US
Practice Address - Phone:214-466-6618
Practice Address - Fax:469-666-9422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty