Provider Demographics
NPI:1619069648
Name:COLLINS, MICHAEL RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RICHARD
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-0179
Mailing Address - Country:US
Mailing Address - Phone:918-967-3368
Mailing Address - Fax:918-967-4582
Practice Address - Street 1:17 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-4010
Practice Address - Country:US
Practice Address - Phone:918-689-3333
Practice Address - Fax:918-967-4582
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20030065832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO90138Medicare UPIN