Callaway, Gordon Derek

Callaway, Gordon Derek is an individual health care provider with primary practice located at 1 Medical Center Dr , Lebanon NH 03756-1000. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Callaway, Gordon Derek can be contacted via phone (603) 650-5599.

Contact Information

Primary practice address
1 Medical Center Dr Lebanon NH 03756-1000
Phone: (603) 650-5599
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 0592 New Hampshire

Profile Details

NPI number 1316968100
LBN Legal business name Callaway, Gordon Derek
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 21st, 2006
Last updated Oct 28th, 2011 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316968100 NPPES
New Hampshire MEDICAID 30334478
New Hampshire MEDICAID 9000303

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