Provider Demographics
NPI:1497133631
Name:COLLIER, BYRON N (DPM)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:N
Last Name:COLLIER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 OAK PARK BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-3406
Mailing Address - Country:US
Mailing Address - Phone:805-481-9100
Mailing Address - Fax:805-481-9199
Practice Address - Street 1:911 OAK PARK BLVD STE 106
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449
Practice Address - Country:US
Practice Address - Phone:805-481-9100
Practice Address - Fax:805-481-9199
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5541213ES0103X
NC682213ER0200X, 213ES0000X, 213ES0103X
MA1338390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program