Provider Demographics
NPI:1902856909
Name:COLLIER, MITCHELL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:J
Last Name:COLLIER
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:PO BOX 1360
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74352-1360
Mailing Address - Country:US
Mailing Address - Phone:918-479-8060
Mailing Address - Fax:918-479-8066
Practice Address - Street 1:609 E MAIN
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:OK
Practice Address - Zip Code:74352
Practice Address - Country:US
Practice Address - Phone:918-479-8060
Practice Address - Fax:918-479-8066
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5N110OtherBCBS AR
OK200001810AMedicaid
OK200001810CMedicaid
AR5N110OtherBCBS AR