Provider Demographics
NPI:1023017514
Name:COLLINS, PAUL DWAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DWAYNE
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-9684
Mailing Address - Country:US
Mailing Address - Phone:910-522-8888
Mailing Address - Fax:910-522-6688
Practice Address - Street 1:923 W 3RD ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-9684
Practice Address - Country:US
Practice Address - Phone:910-522-8888
Practice Address - Fax:910-522-6688
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2037145Medicare ID - Type Unspecified
NCI28148Medicare UPIN