Provider Demographics
NPI:1598808834
Name:COLLINS, FREDERIC JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:JAMES
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 1:101 AUZERAIS CT
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-5703
Mailing Address - Country:US
Mailing Address - Phone:408-358-1094
Mailing Address - Fax:408-356-4384
Practice Address - Street 1:101 AUZERAIS CT
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-5703
Practice Address - Country:US
Practice Address - Phone:408-358-1094
Practice Address - Fax:408-356-4384
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23597207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA42010Medicare UPIN
CA00G235970Medicare ID - Type Unspecified