Provider Demographics
NPI:1568660843
Name:COLLINS, JOHN GREGORY (ND)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GREGORY
Last Name:COLLINS
Suffix:
Gender:M
Credentials:ND
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:GREGORY
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:2907 NE WEIDLER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1758
Mailing Address - Country:US
Mailing Address - Phone:503-493-9155
Mailing Address - Fax:503-493-1578
Practice Address - Street 1:2907 NE WEIDLER ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1758
Practice Address - Country:US
Practice Address - Phone:503-493-9155
Practice Address - Fax:503-493-1578
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR446175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath