Healthcare Provider Details

I. General information

NPI: 1356319438
Provider Name (Legal Business Name): JAMES HENRY GOLLEHER SR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 W BEEBE CAPPS EXPY
SEARCY AR
72143-5012
US

IV. Provider business mailing address

1915 W BEEBE CAPPS EXPY
SEARCY AR
72143-5012
US

V. Phone/Fax

Practice location:
  • Phone: 501-268-8175
  • Fax: 501-268-8337
Mailing address:
  • Phone: 501-268-8175
  • Fax: 501-268-8337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberC4381
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number16642
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2001014623
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number0000036591
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number54240
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number26627
License Number StateSC
# 7
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number26096
License Number StateAL
# 8
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: