Provider Demographics
NPI:1740288117
Name:COLLIER, JAMES LANE (CRNA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LANE
Last Name:COLLIER
Suffix:
Gender:M
Credentials:CRNA
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 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-531-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX577239367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158352802Medicaid
TX8307UBOtherBCBS
TX83899UOtherBLUE CROSS
AR82711OtherBLUE CROSS
TXTIN PLUS 015OtherTRICARE
TX75-1976930-005OtherTRICARE
TX1158352805Medicaid
TX158352803Medicaid
AR154340701Medicaid
TX8339UEOtherBCBS
TXP00933609OtherRAILROAD
TX158352802Medicaid
P87220Medicare UPIN
TXTIN PLUS 015OtherTRICARE
AR154340701Medicaid
TX8B6559Medicare ID - Type Unspecified