Provider Demographics
NPI:1700881042
Name:MCCALLUM, EILEEN LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:LYNN
Last Name:MCCALLUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:
Other - Last Name:MCCALLUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1920 CALIFORNIA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1943
Mailing Address - Country:US
Mailing Address - Phone:530-247-7070
Mailing Address - Fax:530-244-7246
Practice Address - Street 1:1920 CALIFORNIA ST
Practice Address - Street 2:SUITE A
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1943
Practice Address - Country:US
Practice Address - Phone:530-247-7070
Practice Address - Fax:530-244-7246
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA055135207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA055135OtherCALIFORNIA LICENCE NUMBER
CA00A551350OtherPTAN
CA00A551350Medicaid
CA00A551350OtherPTAN
CAG35843Medicare UPIN