Provider Demographics
NPI:1891157806
Name:ST CLAIR, COLLIN A (DO)
Entity Type:Individual
Prefix:
First Name:COLLIN
Middle Name:A
Last Name:ST CLAIR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3099 HELMSDALE PL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2213
Mailing Address - Country:US
Mailing Address - Phone:859-258-6401
Mailing Address - Fax:859-258-6438
Practice Address - Street 1:3099 HELMSDALE PL
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2213
Practice Address - Country:US
Practice Address - Phone:859-258-6401
Practice Address - Fax:859-258-6438
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY04582207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine