Provider Demographics
NPI:1891886313
Name:MCCOLLOUGH, W EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:W
Middle Name:EUGENE
Last Name:MCCOLLOUGH
Suffix:
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 1:1001 S STATE ST
Mailing Address - Street 2:APPLE MEDICAL CENTER AND URGENT CARE INC
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-7635
Mailing Address - Country:US
Mailing Address - Phone:951-925-2525
Mailing Address - Fax:951-925-6834
Practice Address - Street 1:1001 S STATE ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-7635
Practice Address - Country:US
Practice Address - Phone:951-925-2525
Practice Address - Fax:951-929-8825
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG9502207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G950200Medicaid
CA00G950200Medicaid
A95739Medicare UPIN