Provider Demographics
NPI:1497923155
Name:COLLIE, WILLIAM RICHARD IV (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RICHARD
Last Name:COLLIE
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1201 MILITARY RD
Mailing Address - Street 2:STE 2 PMB 269
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-2908
Mailing Address - Country:US
Mailing Address - Phone:501-920-7901
Mailing Address - Fax:501-325-3469
Practice Address - Street 1:17724 INTERSTATE 30
Practice Address - Street 2:STE 2
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-2907
Practice Address - Country:US
Practice Address - Phone:501-920-7901
Practice Address - Fax:501-325-3469
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-15
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARR-2220207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)