Provider Demographics
NPI:1164861027
Name:CALLAHAN, THOMAS (DO)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 E 100 S
Mailing Address - Street 2:STE 15A
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-3003
Mailing Address - Country:US
Mailing Address - Phone:602-406-3153
Mailing Address - Fax:602-406-7176
Practice Address - Street 1:2927 N 7TH AVE
Practice Address - Street 2:PEPPERTREE BUILDING
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4102
Practice Address - Country:US
Practice Address - Phone:602-406-3153
Practice Address - Fax:602-406-7176
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZR2288207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR2288OtherTRAINING PERMIT