Individual
KIT C MCCALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O., MBA
Contact information
Practice address
3620 NW SAMARITAN DR STE 202, CORVALLIS, OR 97330-3785
(541) 768-4810
Mailing address
PO BOX 1189, CORVALLIS, OR 97339-1189
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
147-321
WI
207X00000X
Orthopaedic Surgery Physician
3671
AZ
207X00000X
Orthopaedic Surgery Physician
Primary
DO169772
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
596 009
—
AZ
01
—
Z 119 971
MEDICARE
AZ
Enumeration date
02/04/2006
Last updated
01/26/2021
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