Provider Demographics
NPI:1356725055
Name:COLLINS, BRAEDON J (MD)
Entity type:Individual
Prefix:DR
First Name:BRAEDON
Middle Name:J
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5401 WILLOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-8703
Mailing Address - Country:US
Mailing Address - Phone:479-521-8980
Mailing Address - Fax:479-521-1088
Practice Address - Street 1:5401 WILLOW CREEK DR
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-8703
Practice Address - Country:US
Practice Address - Phone:479-521-8980
Practice Address - Fax:479-521-1088
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NETEP7552208800000X
ARE13359208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology