Provider Demographics
NPI:1649292970
Name:MCCOLLUM, RONALD J (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:MCCOLLUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:601 CLARA BARTON BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5738
Mailing Address - Country:US
Mailing Address - Phone:972-272-6561
Mailing Address - Fax:972-276-3067
Practice Address - Street 1:601 CLARA BARTON BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5738
Practice Address - Country:US
Practice Address - Phone:972-272-6561
Practice Address - Fax:972-276-3067
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD6090207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116428702Medicaid
TX87W701Medicare ID - Type Unspecified
TX116428702Medicaid