Provider Demographics
NPI:1508977364
Name:R DOUGLAS COLLINS, M.D. INC
Entity Type:Organization
Organization Name:R DOUGLAS COLLINS, M.D. INC
Other - Org Name:URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:SALEEM
Authorized Official - Last Name:AKHTAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-849-2526
Mailing Address - Street 1:PO BOX 1509
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-0011
Mailing Address - Country:US
Mailing Address - Phone:951-849-2526
Mailing Address - Fax:951-849-9107
Practice Address - Street 1:1034 W RAMSEY ST # A
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-4442
Practice Address - Country:US
Practice Address - Phone:951-849-2526
Practice Address - Fax:951-849-9107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41586207R00000X, 208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41586OtherSTATE LICENSE NUMBER
CAA29412Medicare UPIN
CA00A415860Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER