Provider Demographics
NPI:1588675722
Name:COLLET, JAMES R (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:COLLET
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PORTNEUF MEDICAL CENTER
Mailing Address - Street 2:651 MEMORIAL DRIVE
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201
Mailing Address - Country:US
Mailing Address - Phone:208-239-2020
Mailing Address - Fax:208-239-3737
Practice Address - Street 1:PORTNEUF MEDICAL CENTER
Practice Address - Street 2:651 MEMORIAL DRIVE
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201
Practice Address - Country:US
Practice Address - Phone:208-239-2020
Practice Address - Fax:208-239-3737
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDM8953208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation