Provider Demographics
NPI:1720637069
Name:COLLINS, EDWIN GARY
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:GARY
Last Name:COLLINS
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 1:3676 E RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-2203
Mailing Address - Country:US
Mailing Address - Phone:702-624-7769
Mailing Address - Fax:702-300-5028
Practice Address - Street 1:3676 E RUSSELL RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-2203
Practice Address - Country:US
Practice Address - Phone:702-624-7769
Practice Address - Fax:702-300-5028
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider