Individual
CHAD R MCCOLLUM
Active
Individual
CHAD R MCCOLLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
5259
AZ
363AM0700X
Medical Physician Assistant
5259
AZ
363AS0400X
Surgical Physician Assistant
5259
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
744737
—
AZ
Enumeration date
09/05/2012
Last updated
03/11/2019
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