Healthcare Provider Details

I. General information

NPI: 1558319962
Provider Name (Legal Business Name): GARY J COLLINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 LILE DR STE 600
LITTLE ROCK AR
72205
US

IV. Provider business mailing address

9501 LILE DR STE 600
LITTLE ROCK AR
72205
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-7596
  • Fax:
Mailing address:
  • Phone: 501-227-7596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberE0728
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: