Provider Demographics
NPI:1447328141
Name:MCCOLLOUGH, ED GAYLON (MD)
Entity type:Individual
Prefix:
First Name:ED
Middle Name:GAYLON
Last Name:MCCOLLOUGH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:350 CYPRESS BEND DRIVE
Mailing Address - Street 2:
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36542
Mailing Address - Country:US
Mailing Address - Phone:251-967-7600
Mailing Address - Fax:251-967-7647
Practice Address - Street 1:350 CYPRESS BEND DRIVE
Practice Address - Street 2:
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542
Practice Address - Country:US
Practice Address - Phone:251-967-7600
Practice Address - Fax:251-967-7647
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2024-09-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL55842082S0099X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
C70220Medicare UPIN