Provider Demographics
NPI:1669476917
Name:COLLINS, CYNTHIA LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LYNNE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13555 W MCDOWELL RD
Mailing Address - Street 2:STE 204
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-2626
Mailing Address - Country:US
Mailing Address - Phone:623-247-0300
Mailing Address - Fax:623-247-9268
Practice Address - Street 1:13555 W MCDOWELL RD
Practice Address - Street 2:STE 204
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-2626
Practice Address - Country:US
Practice Address - Phone:623-247-0300
Practice Address - Fax:623-247-9268
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30257208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ713075Medicaid
71691Medicare ID - Type Unspecified
AZ713075Medicaid