Provider Demographics
NPI:1235297235
Name:COLLINS, DANIEL ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALLEN
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 1:369 MONTEZUMA AVENUE
Mailing Address - Street 2:#446
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-2626
Mailing Address - Country:US
Mailing Address - Phone:505-690-7416
Mailing Address - Fax:
Practice Address - Street 1:369 MONTEZUMA AVENUE
Practice Address - Street 2:#446
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2626
Practice Address - Country:US
Practice Address - Phone:505-690-7416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM98-2412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry