Provider Demographics
NPI:1629079504
Name:MCALLISTER, DANIEL G (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:G
Last Name:MCALLISTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 E BARNETT RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8344
Mailing Address - Country:US
Mailing Address - Phone:541-789-4281
Mailing Address - Fax:541-789-2558
Practice Address - Street 1:2825 E BARNETT RD
Practice Address - Street 2:DEPT OF PEDIATRICS
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8332
Practice Address - Country:US
Practice Address - Phone:541-789-4231
Practice Address - Fax:541-789-5934
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10519208M00000X
TXM4333208000000X
ORMD171590208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0071247Medicaid
I03069Medicare UPIN
MT0071247Medicaid