Provider Demographics
NPI:1427399534
Name:COLLINS, DAVID RAY (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RAY
Last Name:COLLINS
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 1:642 COMMUNITY BEACH RD
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-8210
Mailing Address - Country:US
Mailing Address - Phone:618-532-7939
Mailing Address - Fax:
Practice Address - Street 1:642 COMMUNITY BEACH RD
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-8210
Practice Address - Country:US
Practice Address - Phone:618-532-7939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036057092207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine