Provider Demographics
NPI:1912990227
Name:COLLINS, JOHN W JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:COLLINS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3709 S BOLGER CT
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-3971
Mailing Address - Country:US
Mailing Address - Phone:816-254-4800
Mailing Address - Fax:816-254-4641
Practice Address - Street 1:19550 E 39TH ST S
Practice Address - Street 2:SUITE 400
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2303
Practice Address - Country:US
Practice Address - Phone:816-254-4800
Practice Address - Fax:816-254-4641
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2019-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR3688174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200255602Medicaid
MOD96201Medicare UPIN
MO200255602Medicaid