Healthcare Provider Details

I. General information

NPI: 1487848545
Provider Name (Legal Business Name): WILLIAM LEWIS MCCOLGAN III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 DAVE WARD DR STE 201
CONWAY AR
72034-8680
US

IV. Provider business mailing address

2425 DAVE WARD DR STE 201
CONWAY AR
72034-8680
US

V. Phone/Fax

Practice location:
  • Phone: 501-504-2737
  • Fax: 501-504-2798
Mailing address:
  • Phone: 501-504-2737
  • Fax: 15-042-7985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberE5948
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: