Individual
DR. MICHAEL WALLACE COLGROVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1500 DODSON AVE STE 230, FORT SMITH, AR 72901-5179
(479) 709-7490
(479) 709-7495
Mailing address
11001 EXECUTIVE CENTER DR STE 200, LITTLE ROCK, AR 72211-4393
(479) 709-7490
(479) 709-7495
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
E8309
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201771001
—
AR
Enumeration date
05/10/2007
Last updated
07/16/2024
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