Provider Demographics
NPI:1396815627
Name:MCCOLLUM, WILLIAM E (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:E
Last Name:MCCOLLUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:201 N 36TH ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-1750
Mailing Address - Country:US
Mailing Address - Phone:479-621-8600
Mailing Address - Fax:479-621-8661
Practice Address - Street 1:201 N 36TH ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-1750
Practice Address - Country:US
Practice Address - Phone:479-621-8600
Practice Address - Fax:479-621-8661
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC64572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR101217001Medicaid
AR53464OtherAR BCBS
AR101217001Medicaid
AR53464OtherAR BCBS