Provider Demographics
NPI:1306072269
Name:WILLIAM L. MCCOLGAN, III, M.D., PA
Entity type:Organization
Organization Name:WILLIAM L. MCCOLGAN, III, M.D., PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:MCCOLGAN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:501-504-2737
Mailing Address - Street 1:2425 DAVE WARD DR STE 201
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8680
Mailing Address - Country:US
Mailing Address - Phone:501-504-2737
Mailing Address - Fax:501-504-2798
Practice Address - Street 1:2425 DAVE WARD DR STE 201
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8680
Practice Address - Country:US
Practice Address - Phone:501-504-2737
Practice Address - Fax:501-504-2798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-05
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-5948208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR179822002Medicaid