Provider Demographics
NPI:1598795973
Name:COLLINS, MICHAEL RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RAY
Last Name:COLLINS
Suffix:
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 1:3400 FRANK PHILLIPS BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-2495
Mailing Address - Country:US
Mailing Address - Phone:918-331-2522
Mailing Address - Fax:918-331-2539
Practice Address - Street 1:3400 FRANK PHILLIPS BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2495
Practice Address - Country:US
Practice Address - Phone:918-331-2522
Practice Address - Fax:918-331-2539
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17344174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100061520AMedicaid
OK100061520AMedicaid
OK800522040Medicare ID - Type Unspecified