1104074137 NPI number — DARRYL DEWITT COLLINS, M.D.,P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104074137 NPI number — DARRYL DEWITT COLLINS, M.D.,P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DARRYL DEWITT COLLINS, M.D.,P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104074137
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
213 CEDAR DR
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78374-2921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-777-2886
Provider Business Mailing Address Fax Number:
361-777-3667

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
213 CEDAR DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78374-2921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-777-2886
Provider Business Practice Location Address Fax Number:
361-777-3667
Provider Enumeration Date:
09/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
COLLINS
Authorized Official First Name:
DARRYL
Authorized Official Middle Name:
DEWITT
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
361-777-2886

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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