Provider Demographics
NPI:1750472486
Name:COLLIER, WILLIAM MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MATTHEW
Last Name:COLLIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MATT
Other - Middle Name:
Other - Last Name:COLLIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:795 EASTERN BYP
Mailing Address - Street 2:MEDICAL BLDG.# 2 SUITE 5
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2406
Mailing Address - Country:US
Mailing Address - Phone:859-624-2229
Mailing Address - Fax:859-625-9458
Practice Address - Street 1:795 EASTERN BYP
Practice Address - Street 2:MEDICAL BLDG.# 2 SUITE 5
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2406
Practice Address - Country:US
Practice Address - Phone:859-624-2229
Practice Address - Fax:859-625-9458
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40492207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY40492OtherMEDICAL LICENSE NUMBER
KY000000495871OtherANTHEM BLUE CROSS & BLUE SHIELD
KY64128788Medicaid
KY40492OtherMEDICAL LICENSE NUMBER