MEDICARE: DONALD M COLLINS MD

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	207R00000X	Internal Medicine Physician	ME82417	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01654	OTHER	FL	BLUE CROSS
2	7635287	OTHER	FL	AETNA PPO POS

General Provider Information

NPI Number	:	1366559700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD M COLLINS MD

Provider Business Mailing Address
First Line	:	1109 LUCERNE TERRACE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32806
Country	:	US
Telephone Number	:	407-843-4251
Fax Number	:	407-843-6461

Provider Business Practice Location Address
First Line	:	1109 LUCERNE TERRACE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32806
Country	:	US
Telephone Number	:	407-843-4251
Fax Number	:	407-843-6461

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	05/15/2008

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