Provider Demographics
NPI:1356319438
Name:GOLLEHER, JAMES HENRY SR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HENRY
Last Name:GOLLEHER
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 W BEEBE CAPPS EXPY
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-5012
Mailing Address - Country:US
Mailing Address - Phone:501-268-8175
Mailing Address - Fax:501-268-8337
Practice Address - Street 1:1915 W BEEBE CAPPS EXPY
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-5012
Practice Address - Country:US
Practice Address - Phone:501-268-8175
Practice Address - Fax:501-268-8337
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4381207ZP0102X
MS16642207ZP0102X
MO2001014623207ZP0102X
TN0000036591207ZP0102X
GA54240207ZP0102X
SC26627207ZP0102X
AL26096207ZP0102X
NC207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR18019OtherMEDICARE GROUP
AR71044582830OtherQUALCHOICE
AR56822OtherMEDICARE PROFESSIONAL
ARB90227Medicare UPIN
AR71044582830OtherQUALCHOICE