Provider Demographics
NPI:1366658221
Name:COLLINGS, JOHN W (PAC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:COLLINGS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:LOS ALAMOS NATIONAL LAB
Mailing Address - Street 2:PO BOX 1663 MS D421
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87545-0001
Mailing Address - Country:US
Mailing Address - Phone:505-667-7890
Mailing Address - Fax:
Practice Address - Street 1:LOS ALAMOS NATIONAL LAB
Practice Address - Street 2:OCCUPATIONAL MED DEPT
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87545-0001
Practice Address - Country:US
Practice Address - Phone:505-667-7890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMPA89-03363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant