# WM. WADE COLLISON MD

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Prescott Plastic Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548593916
- **Authorized official:** DR. WILLIAM WADE COLLISON M.D. (OWNER)
- **Authorized official phone:** (928) 778-3838

## Contact information

- **Practice address:** 1050 GAIL GARDNER WAY, SUITE 200, PRESCOTT, AZ 86305-1630
- **Practice address phone:** (928) 778-3838
- **Practice address fax:** (928) 778-5630
- **Mailing address:** 1050 GAIL GARDNER WAY, SUITE 200, PRESCOTT, AZ 86305-1630
- **Mailing address phone:** (928) 778-3838
- **Mailing address fax:** (928) 778-5630

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 10644 | AZ | Yes |

## Other

- **Enumeration date:** 09/16/2009
- **Last updated:** 09/16/2009