Provider Demographics
NPI:1912904343
Name:COLLIER, JOHN W (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:COLLIER
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 1:8291 W BEECHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FRENCH LICK
Mailing Address - State:IN
Mailing Address - Zip Code:47432-9377
Mailing Address - Country:US
Mailing Address - Phone:812-936-7720
Mailing Address - Fax:812-936-7734
Practice Address - Street 1:8291 W BEECHWOOD AVE
Practice Address - Street 2:
Practice Address - City:FRENCH LICK
Practice Address - State:IN
Practice Address - Zip Code:47432-9377
Practice Address - Country:US
Practice Address - Phone:812-936-7720
Practice Address - Fax:812-936-7734
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025128207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000183632OtherANTHEM
IN1003330408Medicaid
IN1003330408Medicaid
000000183632OtherANTHEM