Provider Demographics
NPI:1538461090
Name:RICHARD EARLE COLLIER MD PA
Entity Type:Organization
Organization Name:RICHARD EARLE COLLIER MD PA
Other - Org Name:RICHARD EARLE COLLIER, JR., M.D., P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-539-5566
Mailing Address - Street 1:1501 RIVER POINTE DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2656
Mailing Address - Country:US
Mailing Address - Phone:936-539-5566
Mailing Address - Fax:936-539-5774
Practice Address - Street 1:1501 RIVER POINTE DR
Practice Address - Street 2:SUITE 150
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2656
Practice Address - Country:US
Practice Address - Phone:936-539-5566
Practice Address - Fax:936-539-5774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1635208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099985601Medicaid
TX099985601Medicaid
TX00RG15Medicare PIN