Provider Demographics
NPI:1255461745
Name:BOLLINS, JOHN PATRICK
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PATRICK
Last Name:BOLLINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 E 1ST ST
Mailing Address - Street 2:STE. 302
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2201
Mailing Address - Country:US
Mailing Address - Phone:218-249-6050
Mailing Address - Fax:218-249-6055
Practice Address - Street 1:920 E 1ST ST
Practice Address - Street 2:STE. 302
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2201
Practice Address - Country:US
Practice Address - Phone:218-249-6050
Practice Address - Fax:218-249-6055
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN49932208600000X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN020002416Medicare PIN