Provider Demographics
NPI:1740389279
Name:COLLINS, STEPHEN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:COLLINS
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 1:207A FOB JAMES DRIVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-5079
Mailing Address - Country:US
Mailing Address - Phone:334-756-6205
Mailing Address - Fax:334-756-3783
Practice Address - Street 1:207A FOB JAMES DRIVE
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-5079
Practice Address - Country:US
Practice Address - Phone:334-756-6205
Practice Address - Fax:334-756-3783
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00014412207W00000X
GA033554207W00000X
OH35051354207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
62138189636854A001OtherTRICARE FOR LIFE
A17712Medicare UPIN