Provider Demographics
NPI:1801035035
Name:COLLMAN, DWIGHT D (MD)
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:D
Last Name:COLLMAN
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 1:6013 NW 32ND WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-3364
Mailing Address - Country:US
Mailing Address - Phone:561-305-8163
Mailing Address - Fax:
Practice Address - Street 1:6013 NW 32ND WAY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-3364
Practice Address - Country:US
Practice Address - Phone:561-305-8163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-122526207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-122526OtherLICENSE NUMBER