Provider Demographics
NPI:1730441023
Name:ELBERT C COLLINS MD
Entity type:Organization
Organization Name:ELBERT C COLLINS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-479-9484
Mailing Address - Street 1:726 NW BELLEVUE PL
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526
Mailing Address - Country:US
Mailing Address - Phone:541-479-9484
Mailing Address - Fax:
Practice Address - Street 1:18173 REDWOOD HWY
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:OR
Practice Address - Zip Code:97538
Practice Address - Country:US
Practice Address - Phone:541-597-2464
Practice Address - Fax:541-597-4280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14732207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty