Provider Demographics
NPI:1801834148
Name:COLLIN, GARY RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:RICHARD
Last Name:COLLIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1970 ROANOKE BLVD
Mailing Address - Street 2:SALEM VA MEDICAL CENTER-DEPT. OF SURGERY (112)
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-6404
Mailing Address - Country:US
Mailing Address - Phone:540-982-2463
Mailing Address - Fax:540-983-1090
Practice Address - Street 1:1970 ROANOKE BLVD
Practice Address - Street 2:SALEM VA MEDICAL CENTER-DEPT. OF SURGERY (112)
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-6404
Practice Address - Country:US
Practice Address - Phone:540-982-2463
Practice Address - Fax:540-983-1090
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-07-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101051026208600000X, 2086S0102X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery