Provider Demographics
NPI:1811977838
Name:COLCLASURE, JOE B (MD)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:B
Last Name:COLCLASURE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10201 KANIS RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6203
Mailing Address - Country:US
Mailing Address - Phone:501-227-5050
Mailing Address - Fax:501-227-5151
Practice Address - Street 1:4020 RICHARDS RD STE B
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2744
Practice Address - Country:US
Practice Address - Phone:501-975-7550
Practice Address - Fax:501-975-7553
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARC4019207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR104010001Medicaid
AR51114Medicare PIN