Provider Demographics
NPI:1629142088
Name:COLLINS, SPOTSWOOD THOMSON (PAC)
Entity Type:Individual
Prefix:
First Name:SPOTSWOOD
Middle Name:THOMSON
Last Name:COLLINS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:SPOTSWOOD
Other - Middle Name:T
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PAC
Mailing Address - Street 1:MSC06 3870 1 UNIV OF NM
Mailing Address - Street 2:UNM STUDENT HEALTH CENTER
Mailing Address - City:ALBUQURQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-277-3136
Mailing Address - Fax:505-277-5668
Practice Address - Street 1:MSC06 3870 1 UNIVERSITY OF NEW MEXICO
Practice Address - Street 2:UNM STUDENT HEALTH CENTER
Practice Address - City:ALBUQURQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-277-3136
Practice Address - Fax:505-277-5668
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM86PA2805363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant