Provider Demographics
NPI:1215925821
Name:MACCOLLUM, BARBARA J (MD)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:J
Last Name:MACCOLLUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:J
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3020 E CAMELBACK RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5059
Mailing Address - Country:US
Mailing Address - Phone:602-264-9100
Mailing Address - Fax:602-264-9101
Practice Address - Street 1:1300 N 12TH ST
Practice Address - Street 2:SUITE 613
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2848
Practice Address - Country:US
Practice Address - Phone:602-254-5321
Practice Address - Fax:602-254-6582
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15579207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ317047OtherMEDICAID GROUP NUMBER
AZ120390OtherMEDICARE GROUP NUMBER
AZ260240Medicaid
AZ317047OtherMEDICAID GROUP NUMBER
10WCHWR03Medicare ID - Type Unspecified
AZ260240Medicaid