Individual
DR. CALVIN A. FUNKHOUSER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
500 J CLYDE MORRIS BLVD DEPT OF, NEWPORT NEWS, VA 23601-1929
(757) 612-7200
(757) 594-3184
Mailing address
68 CROATAN RD, NEWPORT NEWS, VA 23606-2617
(540) 421-5557
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110001910
VA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
0116035964
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010117801
—
VA
01
—
P00263494
RAILROAD MEDICARE
VA
Enumeration date
04/28/2006
Last updated
07/08/2021
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