Provider Demographics
NPI:1568410934
Name:COLLINS, EDWARD J JR (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:COLLINS
Suffix:JR
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 1:22974 OVERSEAS HWY
Mailing Address - Street 2:
Mailing Address - City:CUDJOE KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33042-4254
Mailing Address - Country:US
Mailing Address - Phone:305-745-7353
Mailing Address - Fax:305-745-7360
Practice Address - Street 1:8151 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-3200
Practice Address - Country:US
Practice Address - Phone:305-745-7353
Practice Address - Fax:305-745-7360
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT17715207XX0005X
FLME95584207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277479800Medicaid
FLP00445281OtherRAILROAD MEDICARE
FL93135OtherBC BS
FL277479800Medicaid
FLP00445281OtherRAILROAD MEDICARE