Individual
DR. COLLIE BLEVINS SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2200 ADA AVE, SUITE 202, CONWAY, AR 72034-4985
(501) 327-3929
(501) 329-3816
Mailing address
2200 ADA AVE, SUITE 202, CONWAY, AR 72034-4985
(501) 327-3929
(501) 329-3816
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
C7970
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127214001
—
AR
Enumeration date
07/12/2005
Last updated
07/10/2007
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