Provider Demographics
NPI:1942234059
Name:COLLINS, TIMOTHY M (DO)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:M
Last Name:COLLINS
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 1:400 W ARBROOK BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-3107
Mailing Address - Country:US
Mailing Address - Phone:817-801-1456
Mailing Address - Fax:817-801-0594
Practice Address - Street 1:400 W ARBROOK BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-3107
Practice Address - Country:US
Practice Address - Phone:817-801-1456
Practice Address - Fax:817-801-0594
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7454207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134228908Medicaid
TX134228902Medicaid
TX134228908Medicaid
TXF95282Medicare UPIN
TX8933B9Medicare ID - Type Unspecified