Healthcare Provider Details

I. General information

NPI: 1396815627
Provider Name (Legal Business Name): WILLIAM E MCCOLLUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/16/2013
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: 479-621-8661
Mailing address:
  • Phone: 479-621-8600
  • Fax: 479-621-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC6457
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: