Provider Demographics
NPI:1740276583
Name:COLLINS, RICHARD LEO (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:LEO
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 E LINCOLN DR
Mailing Address - Street 2:# 105
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-4119
Mailing Address - Country:US
Mailing Address - Phone:480-948-6416
Mailing Address - Fax:
Practice Address - Street 1:5525 E LINCOLN DR
Practice Address - Street 2:# 105
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-4119
Practice Address - Country:US
Practice Address - Phone:480-948-6416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5016207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0028820OtherBLUE CROSS BLUE SHIELD
AZ224337-04OtherSTATE AHCCS
AZ224337-04OtherSTATE AHCCS
AZAZ0028820OtherBLUE CROSS BLUE SHIELD