Provider Demographics
NPI:1437307170
Name:COLLIER COUNTY MEDICAL, INC.
Entity Type:Organization
Organization Name:COLLIER COUNTY MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHSIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAFAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-566-1332
Mailing Address - Street 1:870 111TH AVE N
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-1869
Mailing Address - Country:US
Mailing Address - Phone:239-566-1332
Mailing Address - Fax:239-566-1332
Practice Address - Street 1:870 111TH AVE N
Practice Address - Street 2:SUITE 2
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-1869
Practice Address - Country:US
Practice Address - Phone:239-566-1332
Practice Address - Fax:239-566-1332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-06
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 102512261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care