Provider Demographics
NPI:1740214816
Name:COLLINGE, CORY A (MD)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:A
Last Name:COLLINGE
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 1:800 5TH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7303
Mailing Address - Country:US
Mailing Address - Phone:817-878-5300
Mailing Address - Fax:817-878-5321
Practice Address - Street 1:800 5TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7303
Practice Address - Country:US
Practice Address - Phone:817-878-5300
Practice Address - Fax:817-878-5321
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD53043207XX0801X
TXK8090207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX037065202Medicaid
TX037065202Medicaid
G96853Medicare UPIN