Provider Demographics
NPI:1851592018
Name:COLLINS, RONALD BENJAMIN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:BENJAMIN
Last Name:COLLINS
Suffix:JR
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 1:210 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-1898
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 4TH AVE
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-1898
Practice Address - Country:US
Practice Address - Phone:641-236-2382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125050346207R00000X
IA39422207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCA4079OtherRR MEDICARE GROUP PTAN
IL036119753Medicaid
IL809840OtherMEDICARE GROUP PTAN
ILP00617107OtherRR MEDICARE MEMBER PTAN
IA1669420501Medicaid
IAI17380OtherMEDICARE PTAN
ILP00617107OtherRR MEDICARE MEMBER PTAN
ILR01312Medicare PIN