Healthcare Provider Details

I. General information

NPI: 1265494231
Provider Name (Legal Business Name): JOHN COLLERAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 01/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 RICHARDS RD SUITE A
NORTH LITTLE ROCK AR
72117-2650
US

IV. Provider business mailing address

10100 KANIS RD
LITTLE ROCK AR
72205-6202
US

V. Phone/Fax

Practice location:
  • Phone: 501-758-5133
  • Fax: 501-758-5173
Mailing address:
  • Phone: 501-255-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOS7028
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberE-5551
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: