Provider Demographics
NPI:1457329468
Name:COLLIN, BERJAN (MD)
Entity Type:Individual
Prefix:MR
First Name:BERJAN
Middle Name:
Last Name:COLLIN
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 1:356 E MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-7148
Mailing Address - Country:US
Mailing Address - Phone:772-464-9746
Mailing Address - Fax:772-464-9750
Practice Address - Street 1:1801 SE HILLMOOR DR
Practice Address - Street 2:STE C 207
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7553
Practice Address - Country:US
Practice Address - Phone:772-335-4234
Practice Address - Fax:772-335-4236
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 74857207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256322300Medicaid
FL46231Medicare PIN
FL256322300Medicaid