Provider Demographics
NPI:1396476628
Name:COLLINS, BRODIE GARRISON (DPM)
Entity type:Individual
Prefix:
First Name:BRODIE
Middle Name:GARRISON
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34869
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-0626
Mailing Address - Country:US
Mailing Address - Phone:858-450-9218
Mailing Address - Fax:
Practice Address - Street 1:39755 MURRIETA HOT SPRINGS RD STE D130
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-9110
Practice Address - Country:US
Practice Address - Phone:951-698-4611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT18-2022213E00000X
CAE6124213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist