# DR. ALFONZA MCCOLLUM JR.

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1407844558
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | ME83401 | FL | Yes |

## Other

- **Enumeration date:** 10/12/2005
- **Last updated:** 11/30/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1407844558 | TRICARE | FL |
| 05 | — | 267116600 | — | FL |
| 01 | — | 57851 | BCBS | FL |
| 01 | — | P00444511 | RAILROAD MEDICARE NUMBER | FL |