Provider Demographics
NPI:1396738373
Name:COLLINS, GARY T (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:T
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3922 WOODLEY RD
Mailing Address - Street 2:STE 100
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1130
Mailing Address - Country:US
Mailing Address - Phone:419-291-2121
Mailing Address - Fax:419-479-6017
Practice Address - Street 1:3922 WOODLEY RD
Practice Address - Street 2:STE 100
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1130
Practice Address - Country:US
Practice Address - Phone:419-291-2121
Practice Address - Fax:419-479-6017
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2023-11-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35045187208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH370012693OtherRRMC
MI4002372OtherAETNA
MI000000216338OtherANTHEM
OH0524756OtherBCMH
OH12-01285OtherUHC
OH000000141258OtherANTHEM
MI12-03666OtherUHC
OH0633282OtherAETNA
OH00007OtherPHC
OH0534756Medicaid
MI3505802341OtherBCBS MI
OHF89011Medicare UPIN
OH370012693OtherRRMC
OHCO0769763Medicare ID - Type Unspecified