Provider Demographics
NPI:1982691705
Name:COLLINS, DAVID ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ERIC
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 1:2350 W EL CAMINO REAL FL 2
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6203
Mailing Address - Country:US
Mailing Address - Phone:510-504-8140
Mailing Address - Fax:510-506-7721
Practice Address - Street 1:5401 NORRIS CANYON RD
Practice Address - Street 2:SUITE 306
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5409
Practice Address - Country:US
Practice Address - Phone:925-277-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG687392084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0017862Medicaid
CAG68739OtherSTATE MEDICAL LICENSE
CAGR0017862Medicaid