Provider Demographics
NPI:1043220874
Name:COLLINS, WARREN PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:PATRICK
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 1:1342 E PRIMROSE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4279
Mailing Address - Country:US
Mailing Address - Phone:417-869-3200
Mailing Address - Fax:417-869-3212
Practice Address - Street 1:1342 E PRIMROSE ST
Practice Address - Street 2:SUITE B
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4279
Practice Address - Country:US
Practice Address - Phone:417-869-3200
Practice Address - Fax:417-869-3212
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114662207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO90-0259728OtherTAX ID
MO203814702Medicaid
AR169344001Medicaid
AR169344001Medicaid
MOG34643Medicare UPIN
MO942145017Medicare PIN