Provider Demographics
NPI:1184641797
Name:COLLINS, MARK F (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:F
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1325 PENNSYLVANIA AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2100
Mailing Address - Country:US
Mailing Address - Phone:817-332-9957
Mailing Address - Fax:817-336-3130
Practice Address - Street 1:1000 9TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3906
Practice Address - Country:US
Practice Address - Phone:817-927-2329
Practice Address - Fax:817-924-0177
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG6709208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP02531907OtherMEDICARE RAIL ROAD
TX010066226OtherRAIL ROAD MEDICARE
TX031762003Medicaid