Provider Demographics
NPI:1942252606
Name:COLLIER, JAMES M III (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:COLLIER
Suffix:III
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 1:169 BURT RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2455
Mailing Address - Country:US
Mailing Address - Phone:859-278-9242
Mailing Address - Fax:859-278-0322
Practice Address - Street 1:135 E MAXWELL ST
Practice Address - Street 2:STE. 303
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2640
Practice Address - Country:US
Practice Address - Phone:859-425-1117
Practice Address - Fax:859-425-1130
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20763207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64207632Medicaid
KYP00151867OtherRR MEDICARE
KYC64446Medicare UPIN
KY64207632Medicaid