Provider Demographics
NPI:1033321203
Name:FREDERIC J COLLINS MD INC
Entity Type:Organization
Organization Name:FREDERIC J COLLINS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FREDERIC
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-358-1094
Mailing Address - Street 1:101 AUZERAIS CT.
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-5703
Mailing Address - Country:US
Mailing Address - Phone:408-358-1094
Mailing Address - Fax:408-356-4384
Practice Address - Street 1:101 AUZERAIS CT.
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-5703
Practice Address - Country:US
Practice Address - Phone:408-358-1094
Practice Address - Fax:408-356-4384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23597207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA42010Medicare UPIN
CA00G235970Medicare ID - Type Unspecified