Bollen, Altimus Ray
Bollen, Altimus Ray is an individual health care provider with primary practice located at 1002 Schneider Dr Suite 104, Malvern AR 72104-4816. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Bollen, Altimus Ray can be contacted via phone (501) 337-9066.Contact Information
Primary practice address
1002 Schneider Dr Suite 104
Malvern AR 72104-4816
Phone: (501) 337-9066
Fax: (501) 332-5265
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | C6072 | Arkansas |
Profile Details
| NPI number | 1720054125 |
|---|---|
| LBN Legal business name | Bollen, Altimus Ray |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 24th, 2006 |
| Last updated | May 22nd, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1720054125 | NPPES |
| Arkansas | Other | P00046 | NOVASYS |
| Arkansas | Other | 5401027 | NOVASYS |
| Arkansas | MEDICAID | 102657001 | NOVASYS |
| Arkansas | Other | 12692000000 | NOVASYS |
| Arkansas | Other | 9292900 | NOVASYS |
| Arkansas | Other | 277387 | NOVASYS |
| Arkansas | Other | MG38450 | NOVASYS |
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