Provider Demographics
NPI:1205895646
Name:COLLINS, JEROME S (MD)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:S
Last Name:COLLINS
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 1:1900 BOISE AVE
Mailing Address - Street 2:STE 420
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-5004
Mailing Address - Country:US
Mailing Address - Phone:970-669-3212
Mailing Address - Fax:
Practice Address - Street 1:1900 BOISE AVE
Practice Address - Street 2:STE 420
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-5004
Practice Address - Country:US
Practice Address - Phone:970-669-3212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23898208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01238989Medicaid
CO01238989Medicaid
COD24346Medicare UPIN