Individual
MR. GORDON DEREK CALLAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1 MEDICAL CENTER DR, LEBANON, NH 03756-1000
(603) 650-5599
Mailing address
1 MEDICAL CENTER DR, LEBANON, NH 03756-1000
(603) 650-5599
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0592
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30334478
—
NH
05
—
9000303
—
VT
Enumeration date
07/21/2006
Last updated
10/28/2011
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