Individual
DR. ALFONZA MCCOLLUM JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
461 SOUTH NOVA ROAD, ORMOND BEACH, FL 33174-6138
(386) 671-4337
(386) 671-7242
Mailing address
P.O. BOX 9671, DAYTONA BEACH, FL 32120-9671
(386) 676-7130
(386) 676-7125
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME83401
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407844558
TRICARE
FL
05
—
267116600
—
FL
01
—
57851
BCBS
FL
01
—
P00444511
RAILROAD MEDICARE NUMBER
FL
Enumeration date
10/12/2005
Last updated
11/30/2015
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