Provider Demographics
NPI:1326160425
Name:COLLIER, DORWYN CRAIG (DO)
Entity Type:Individual
Prefix:
First Name:DORWYN
Middle Name:CRAIG
Last Name:COLLIER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 WINDSOR COURT
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514
Mailing Address - Country:US
Mailing Address - Phone:574-266-6555
Mailing Address - Fax:574-266-6888
Practice Address - Street 1:3100 WINDSOR COURT
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514
Practice Address - Country:US
Practice Address - Phone:574-266-6555
Practice Address - Fax:574-266-6888
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001521A207Q00000X, 2083P0500X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN02001521AOtherLICENSE NUMBER
IN200097620Medicaid
IN02001521AOtherLICENSE NUMBER