MEDICARE: TIMMY DEONCAY COLLIER JR.

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	207Q00000X	Family Medicine Physician	2018001016	MO

General Provider Information

NPI Number	:	1659218931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMMY DEONCAY COLLIER JR.

Provider Business Mailing Address
First Line	:	7606 QUINN SPRING CT
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20783-2200
Country	:	US
Telephone Number	:	573-855-9998
Fax Number	:

Provider Business Practice Location Address
First Line	:	7606 QUINN SPRING CT
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20783-2200
Country	:	US
Telephone Number	:	301-295-9004
Fax Number	:

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

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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