Provider Demographics
NPI:1871664581
Name:COLLET, BARRY S (DPM)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:S
Last Name:COLLET
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 TORREY ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4696
Mailing Address - Country:US
Mailing Address - Phone:508-583-3110
Mailing Address - Fax:
Practice Address - Street 1:478 TORREY ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4696
Practice Address - Country:US
Practice Address - Phone:508-583-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1489213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA33027OtherHARVARD PILGRIM
MA0336475Medicaid
MAY70647OtherBLUE CROSS
MAY70647OtherBLUE CROSS
MAT58702Medicare ID - Type Unspecified