Provider Demographics
NPI:1376619726
Name:COLLIER, BRIAN KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KEITH
Last Name:COLLIER
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 1:11440 PARKSIDE DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2658
Mailing Address - Country:US
Mailing Address - Phone:865-925-9020
Mailing Address - Fax:865-377-1042
Practice Address - Street 1:11440 PARKSIDE DR
Practice Address - Street 2:SUITE 302
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-2658
Practice Address - Country:US
Practice Address - Phone:865-925-9020
Practice Address - Fax:865-377-1042
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16447207R00000X
TNMD0000021257207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051084387OtherBC BS OF ALABAMA NUMBER
TN30593201Medicaid
AL000084387Medicaid
TN30593201Medicaid
TN30593201Medicare PIN
AL000084387Medicare ID - Type UnspecifiedMEDICARE NUMBER