Provider Demographics
NPI:1770584633
Name:SOLLINS, JEFFREY S (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:SOLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7510 MONTGOMERY BLVD NE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1500
Mailing Address - Country:US
Mailing Address - Phone:505-855-5545
Mailing Address - Fax:505-855-5541
Practice Address - Street 1:7510 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE 203
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1500
Practice Address - Country:US
Practice Address - Phone:505-855-5545
Practice Address - Fax:505-855-5541
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2008-02-22
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-04-17
Provider Licenses
StateLicense IDTaxonomies
NM77-264207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMC98108Medicare UPIN