Provider Demographics
NPI:1346456852
Name:COLLINS, WILLIE MACARTHUR (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:MACARTHUR
Last Name:COLLINS
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9442 INTERNATIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94603-1444
Mailing Address - Country:US
Mailing Address - Phone:510-777-8448
Mailing Address - Fax:510-777-8453
Practice Address - Street 1:9442 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94603-1444
Practice Address - Country:US
Practice Address - Phone:510-777-8448
Practice Address - Fax:510-777-8453
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA 10172363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant