Healthcare Provider Details

I. General information

NPI: 1992930903
Provider Name (Legal Business Name): WILLIAM E. MCCOLLUM, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N 36TH ST
ROGERS AR
72756-1750
US

IV. Provider business mailing address

201 N 36TH ST
ROGERS AR
72756-1750
US

V. Phone/Fax

Practice location:
  • Phone: 479-621-8600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberC-6457
License Number StateAR

VIII. Authorized Official

Name: WILLIAM MCCOLLUM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 479-621-8600