1588829048 NPI number — MR. DARRELL BERNARD COLLIERS CFA PA

Table of content: MR. DARRELL BERNARD COLLIERS CFA PA (NPI 1588829048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588829048 NPI number — MR. DARRELL BERNARD COLLIERS CFA PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLIERS
Provider First Name:
DARRELL
Provider Middle Name:
BERNARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CFA PA
Provider Gender Code:
M

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:
1588829048
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
230 AUDUBON DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANDEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-845-1501
Provider Business Mailing Address Fax Number:
985-845-1601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15200 COMMUNITY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GULFPORT
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-575-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  616147 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 616147 . This is a "NATL 1ST ASSIST CORP" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com