Callaway, Mark Walter
Callaway, Mark Walter is an individual health care provider with primary practice located at 255 Bert Kouns , Shreveport LA 71106. He recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as his primary health care specialty. Callaway, Mark Walter can be contacted via phone (318) 683-0411.Contact Information
Primary practice address
255 Bert Kouns
Shreveport LA 71106
Phone: (318) 683-0411
Fax: (318) 603-5461
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Urology | 208800000X | 013305 | Louisiana |
Profile Details
| NPI number | 1457356933 |
|---|---|
| LBN Legal business name | Callaway, Mark Walter |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 20th, 2005 |
| Last updated | Mar 24th, 2010 - 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1457356933 | NPPES |
| Louisiana | MEDICAID | 1302929 | |
| Louisiana | Other | 340012714 |
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