Healthcare Provider Details

I. General information

NPI: 1144260837
Provider Name (Legal Business Name): DEBORAH MCCOLLUM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBORAH B MCCOLLUM III M.D.

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6611 W AMARILLO BLVD
AMARILLO TX
79106-1755
US

IV. Provider business mailing address

PO BOX 840026
DALLAS TX
75284-0026
US

V. Phone/Fax

Practice location:
  • Phone: 806-212-4535
  • Fax: 806-212-4555
Mailing address:
  • Phone: 806-212-6965
  • Fax: 806-212-6278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberJ8313
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: