Individual
DR. ALTIMUS RAY BOLLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1002 SCHNEIDER DR, SUITE 104, MALVERN, AR 72104-4816
(501) 337-9066
(501) 332-5265
Mailing address
11001 EXECUTIVE CENTER DR, SUITE 200, LITTLE ROCK, AR 72211-4316
(501) 812-7587
(501) 812-7777
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
C6072
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102657001
—
AR
01
—
12692000000
QUALCHOICE
AR
01
—
277387
HEALTHLINK
AR
01
—
5401027
AETNA
AR
01
—
9292900
CIGNA
AR
01
—
MG38450
UNITED HEALTHCARE
AR
01
—
P00046
NOVASYS
AR
Enumeration date
02/24/2006
Last updated
05/22/2008
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