Basic Information
| Provider Information | |||||||||
| NPI: | 1952679219 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALLAWAY | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | WAYNE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | ATP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1315 AVENUE C | ||||||||
| Address2: | |||||||||
| City: | BROWNWOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 768013422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256424765 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 118 S PARK DR STE A | ||||||||
| Address2: | |||||||||
| City: | BROWNWOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 768015957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256433290 | ||||||||
| FaxNumber: | 3256433295 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2011 | ||||||||
| LastUpdateDate: | 12/01/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | 0107430 | TX | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.