MEDICARE: DR. HORACE JAY COLLINSWORTH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	016171	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033118443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HORACE JAY COLLINSWORTH M.D.

Provider Business Mailing Address
First Line	:	8415 GOODWOOD BLVD
Second Line	:	SUITE 100
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-7851
Country	:	US
Telephone Number	:	225-765-5633
Fax Number	:	225-765-5634

Provider Business Practice Location Address
First Line	:	8415 GOODWOOD BLVD
Second Line	:	SUITE 100
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-7851
Country	:	US
Telephone Number	:	225-765-5633
Fax Number	:	225-765-5634

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	02/15/2021

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