Provider Demographics
NPI:1346554854
Name:COLLINS, ANDREW CLAY (DOM)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:CLAY
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3916 CARLISLE BLVD NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4556
Mailing Address - Country:US
Mailing Address - Phone:505-314-3700
Mailing Address - Fax:
Practice Address - Street 1:3916 CARLISLE BLVD NE
Practice Address - Street 2:SUITE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4556
Practice Address - Country:US
Practice Address - Phone:505-314-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1025171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist