MEDICARE: DAVID MICHAEL COLLIS CRNA

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	367500000X	Certified Registered Nurse Anesthetist	759640	TX

General Provider Information

NPI Number	:	1598799678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID MICHAEL COLLIS CRNA

Provider Business Mailing Address
First Line	:	PO BOX 4157
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79704-4157
Country	:	US
Telephone Number	:	432-699-0952
Fax Number	:

Provider Business Practice Location Address
First Line	:	4519 N GARFIELD ST
Second Line	:	SUITE 15
City	:	MIDLAND
State	:	TX
Zip	:	79705-3415
Country	:	US
Telephone Number	:	432-699-0952
Fax Number	:

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	01/27/2012

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Directions to “ DAVID MICHAEL COLLIS CRNA” Practice Location

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