Provider Demographics
NPI:1043458672
Name:W EDWARD COLLINS MD PA
Entity Type:Organization
Organization Name:W EDWARD COLLINS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WELDON
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-835-1333
Mailing Address - Street 1:3070 COLLEGE ST STE 208
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4688
Mailing Address - Country:US
Mailing Address - Phone:409-835-1333
Mailing Address - Fax:409-838-1326
Practice Address - Street 1:3070 COLLEGE ST STE 208
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4688
Practice Address - Country:US
Practice Address - Phone:409-835-1333
Practice Address - Fax:409-835-2629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9316207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty